3 Suggestions for Navigating Medication and Body Image Issues

Something I’ve struggled with for most of my life, like many others, has been my (mostly negative) relationship with how my body looks. When it comes to body image and taking medication, this can make matters worse. Some medications to treat mental health conditions cause weight gain — sometimes dramatically so. Sometimes that has made me feel like I’m being kicked when I’m already down and trying to get up. I still wrestle with accepting my body for what it is today, but I’ve discovered a few techniques and perspectives that have helped. Most of what I offer is for those who are cisgender women, as that’s my experience. So there are some specifics in here, but I hope some of it translates to others who this is not necessarily intended for:

It’s That Time of the Month

It was a recent realization for me that there are certain times of my menstrual cycle when I’m most likely to think negatively about my body. Turns out I’m not alone: One study of adolescents found a link between certain phases of the menstrual cycle and viewing one’s body negatively, after controlling for a variety of factors. When I was in attendance at the International Society for Bipolar Disorders conference, someone remarked to me how little female-specific (as in XX chromosomes) health issues are included in bipolar research. Often the abstracts I’ve found for this topic have been clinical in terms of “how does menstruation affect symptoms” or “what medications change the menstrual cycle.” Personally, the most meaningful information would come from a question like this: “How does the menstrual cycle affect a woman who has bipolar in everyday life, and what can we do to help her cope with those thoughts and feelings?” I’m sure there are better ways of putting it, but the essence points to quality of life. On the ground level, I already know medications influence my body image. What I need is help not feeling like I have to avoid mirrors.

One tool I’ve found helpful is an app called Clue, which is available for both Apple and Android users. I’ve been using it for years and it’s not perfect for the mentally extraordinary mind, but it provides a useful way to monitor one’s period. What I’ve been doing recently is making correlations between my pre-menstrual symptoms and — for the lack of better words — how much I dislike my body. There are definitely trends that I didn’t think about before, but of course make sense now. For example, when I’m bloated and gassy, obviously I’m less likely to think I’m attractive. Even though being aware of that hasn’t completely whisked away my worries, it does help me implement some CBT strategies so I don’t linger on these thoughts too long.

There are, of course, many studies on body image, the culture of “thin,” and other intersecting issues. But the medication, menstruation, bipolar, and body image connection? Someone please point me in that direction.

The Obvious: Exercise!

Sometimes this is a loaded word when it comes to mental illness because of the different “places” people are at in their journeys back to wellness. Exercise is helpful at every point in one’s journey. A meta-analysis (a study of many studies) of university students found that exercise greatly improved symptoms of depression; another large study of studies found that people with bipolar have improved quality of life when exercise is thrown in the mix; and there is a greater than ever push to see exercise as part of treatment. While there can be barriers to exercise, or to exercising regularly, it is a top health priority for whole-body health.

In terms of body image, I know I feel better about myself when I have a regular exercise routine. On average, I work out 5 days a week and spend time outdoors if weather permits. I can afford a studio membership that gives me access to many classes at many times of the day, so I don’t have a lot of excuses not to exercise. However, there was a time when I didn’t have that. At one point in my life, a thirty minute run in the neighbourhood was all I had. But sometimes that’s great — it takes away potential anxiety from going into a gym environment. And even when I didn’t have money for group classes, I used online videos like Do Yoga With Me, which offers free yoga classes in the form of recorded videos. Sometimes, it just takes a little bit of creativity to find an exercise regime that works for you.

Where does the self-loathing come from?

Since I started taking medication, I’ve noticed a steady increase in weight gain. There are some reasons for this: Depression makes exercise pretty difficult, medications can mess with metabolism, an erratic exercise schedule, and an injury all contributed to my current state. That being said, this year I made it a point to get in better shape, which I’ve been fairly successful at. I wish I could say that I’m at peace with my body that’s physically stronger and in better shape than it’s ever been — but it’s simply not so. For me, “self-loathing” is how I describe my feelings; it will surely be different for others. Ironically, it fuels my motivation for exercise — almost like I’m running away from myself. What I really need to do is run toward myself and give myself a hug, because these feelings really do hurt.

In Western culture, we are seeing a movement to body positivity — accepting our bodies for what they are. Yet, there is still a huge emphasis for women to be thin and sexy, and sexy is a fairly narrow category. From a young age, girls are exposed to these standards and taught to believe in these range of ideas. So there’s a large cultural component to the body image conversation — large enough to warrant books and many heated debates over it. What’s important for me in adding this in is to contextualize my feelings in the bigger picture. I’m not alone in thinking and feeling these things. This is not just a mental illness issue (though it certainly could use more research). This is a worldwide issue.

There are certainly mental illness-specific tips and suggestions for navigating body image issues, and the last one I’m presenting is, for many, the tough one. Facing myself, my feelings of inadequacy — these are difficult realities to face. This needs to be done with the proper supports; if possible, with a caring healthcare professional. At the very minimum, with loved ones who will listen non-judgmentally, or even peer support groups. Talking about the effects of medication on one’s well being is a proper conversation to have in a psychiatrist’s office. The take home message is this: Just because someone with a mental illness needs to take medication, that doesn’t mean the medication should impede on quality of life. Medication is a negotiation, not a life sentence.

Gadgets and Guidance for Sound Sleep

Sleep is important for everyone, no matter your mental health experiences. It’s especially important for people who have bipolar. It’s somewhat common knowledge for us folk who do have it that getting an average, healthy night’s sleep is stabilizing. When some people don’t sleep enough (or at all), this can be a sign of an upcoming/existing hypo/manic episode. Years ago, before I was diagnosed with bipolar, I lived a month where I was getting around four hours of sleep every night — in addition to waking up feeling absolutely refreshed and doing a 5k run at 6am. Talk about productivity, right? Well, that’s not sustainable for the body or the mind, unfortunately.

Some research suggests that dysfunctions in the sleep-wake cycle (i.e. part of the circadian rhythms system) are partly responsible for these changes people with bipolar can undergo. However, there are some problems in studying this quality of life area; one study argues that we are still developing ways to understand this situation. It’s a complex biological debate, but nonetheless we can subjectively agree that sleep is important for all areas of health. So over the years I’ve tried out many techniques to help me get better sleep. Here are some tools I use to make sure I find my sweet spot for a good night’s rest.

The Bedtime Routine

It took me a long time to comply with having an adult bedtime (as I’ve written about before). But after so much trial and error, I’ve produced enough personal evidence to know having a fixed sleep and wake hour really does make a difference. I used to see a psychiatrist who was big on sleep hygiene; as much as I hated those lectures, I ended up learning a lot and using that knowledge. Before I get to my sleep routine, let me outline some key gadgets that aid me every night.

Sunrise Alarm Clock Simulator

At first I was skeptical, but if I had to choose one sleep gadget it would be my sunrise simulator alarm clock. I have the Philips HF3520 Wake-Up Light, which looks like this:

It’s pricey, but completely worth it. It has a sundown setting that I time for 30 minutes so by the time I’m done with my routine and in bed, it’s dim and only minutes to turning off. What I also love about this clock is it wakes me up without any noise — just light. I never thought that would work, but it’s made getting up in the morning so much more peaceful. Strangely enough, I even think it’s trained my body to wake up at the same time even if I don’t set the alarm for the dawn simulation. But for days when I might be extra sleepy (like if I have to take extra meds before sleep), it does have nature noises that go off at the exact time the alarm is set. It has really made a difference in my sleep-wake cycle. Another bonus is it doesn’t wake my partner up, who has a completely different sleep schedule than I do.

Aromatherapy Diffuser

I’ve always been big on the uses of smell, probably from growing up in a household that regularly burned incense or used essential oils. One scent that has some evidence behind it in helping sleep and eliciting calmness is lavender. Anecdotally, I know many people who find smelling lavender calming — myself included. So every night when I set my alarm clock timer on, I put some lavender oil in a diffuser that shuts off when it runs out of water. I use this Sage diffuser, which looks like this:

It’s an older model I bought a year or so ago, and I don’t recommend it because the black version that I have is losing its colour, which flakes off and gets in the basin. But it does its job for the time being. What I do recommend is getting a diffuser that does NOT have any external lights, which is a nice segue for another sleep gadget I use.

Towels!

Yes, towels. But it’s only because I’m poor and that’s what I’m currently using to cover my bedroom window so the room is pitch black. There are many curtains and other methods of blocking light from the room, so get creative if need be. In order to get around the different sunset and sunrise times that change throughout the year in my lovely home of Canada, this is one of my necessities. I spent a terrible month without an entirely dark room and my sleep quality was much worse. Having a dark room gives me control over my sleep schedule and apparently does make quite a difference in staying asleep throughout the night (here’s a great article for related ways to help stay asleep during the night). And speaking of fabric…

A Comfy Bed Makes for Comfy Sleep

I have scoliosis, which is a curvature(s) of the spine (which in turn rotates my ribcage so it’s misaligned). Having a comfortable bed is not just good for sleep, but necessary to reduce my physical pain so I can fall asleep. I don’t have a fancy bed, but I do have a memory foam mattress topper that conforms to my body shape. If I sleep on an uncomfortable bed, I wake up in pain. That starts the day with not a great mood, not having slept well, and less energy to concentrate and live my life the way I need to. Mental health and physical health are interconnected in this way and in some many others.

Medication Regime

Since every person who has bipolar takes different medications to manage the condition, this is a topic I can only speak to from my own experience. I only take one medication that makes me drowsy (clonazepam); I take it with the rest of my medications at dinner, which is usually a few hours before I go to bed. Over time, I’ve found this gives me a nice “cooldown”; I don’t feel the drowsy effects for a couple hours. So it’s imperative that I time my medication intake right, otherwise I find myself either not sleepy when I go to bed or too sleepy when I still need to be awake. There was a lot of trial and error involved in figuring out this relationship, but I encourage others to pay attention to how medications influence sleepiness and how they can be used to help guide oneself to sleep.

“As Needed” Medications

The only PRN (pro re nata; “as needed”) I take when I need it is quetiapine. If feeling hungover in the morning sounds awesome, then consider this an awesome medication. It’s something I only use if I’m wide-awake with a billion thoughts that I can’t control even after an extra tablet of clonazepam. Again, this is specific to me and not to be generalized to anyone else. But having a sleep “backup” plan is imperative for people with bipolar; it needs to be a conversation with one’s healthcare practitioner. Sometimes sleep hygiene isn’t going to work, and that’s when medication can be a lifesaver. Reminder: It’s okay to take medication, especially if it prevents deteriorating mental health.

Other Tips

Here are some suggestions that I’ve learned over the year that may or may not work for some:

  • Avoid blue lights, like tablets or phones. However, most devices do come with red/orange light filters. I use f.lux on my Macbook because I often do my best work at night.
  • Use the bedroom for sleep and sex only. Leave the electronics out. Associate that one room with good sleep (and sex, but I suppose you can always move that to other areas of the domicile).
  • Don’t exercise! Or do — I actually find it very unwinding to do intense exercise in the evening, despite what seems to be pop psychology saying the opposite. Another trial and error situation.

That’s about all I can think of in my quetiapine hangover — a hangover which is paradoxically helping me wake up earlier by helping me going to sleep earlier. I do this when I’m about to travel to a different time zone and when I have early flights to catch (like the 6:30am one coming up for me this week). I’ll emphasize again that this is my context and should not be generalized to anyone else. Always collaborate with a healthcare provider before using medication in any way. In my context, this gradual sleep change helps keep my mood and related mental functions as stable as possible. But, of course, medication is only one tool in the toolbox of a sound sleep.

Nuanced Anger

Emotions are complicated for a myriad of reasons. It can be difficult identifying what we’re feeling at any given moment. We may not have the language to express our emotional states. And when we do, sometimes it seems like no one just “gets it.” Anger is an emotion I’m particularly familiar with — even enjoy, depending on the connotation. I wanted to share my “types” of anger in hopes that it will give deeper meaning to how nuanced emotions can be.

Social Anger

One of my favourite ways to be angry is when the rage is sparked by human rights or other injustices in the world. Physically, it feels passionate; it’s like the kind of anger you could have sex with, as ridiculous as that may sound. It’s motivating, inspiring, and has momentum. When I feel socially angry, I feel a call to action and take it. This usually plays out in the form of writing. Sometimes, though, it can feel like it’s consuming me and it becomes counterproductive. That’s when I have to do some serious cardio to tone it down a notch. Otherwise, it’s a fire inside that can get a tad bit too hot. But I love every moment of it.

Sad Anger

I recently discovered this in myself. It’s like a depressed but fiery resentment that wants to lash out but feels too sad to do so. Often it comes with feelings of indignation, but also an underlying current of despair that is certainly invisible on the surface. In a sense it’s an anger that hides pain, that masquerades as defiant rage — fuming on the surface, but moping within. When this feeling shows up, I tend to be short with people and have an overwhelming sense to escape but also to take it out on someone. Inside my head I’m telling myself that I was right to feel a certain way about something and that no one seems to understand that.

Stubborn Anger

“I’m not moving on this,” I say to myself when I know I’m right and channeling hate at a certain concept, situation, or person. On many occasions I have linked this specific anger with bureaucracy; it’s different from social anger in that I find it extremely unpleasant to feel. Stubborn anger feels stressful and comes with an unending barrage of unpleasant thoughts. This anger lingers in a very unproductive way, in a way that can lead to sad anger but doesn’t always. I don’t use the word “hate” often, but if I were to use it I would probably be feeling stubborn anger.

And sometimes I’m just angry.

Part of the package of my bipolar is just being angry sometimes. There’s no thought to trace it to, no circumstance, no behaviours that went into it or go out of it. Perhaps it’s akin to feeling uncomfortable. I’ve found that clinicians have pathologized this with me in the past beyond saying “it’s just part of the package deal.” Anger can exist by itself. It can rise to the surface as if to say, “Hey, just doing the rounds today. Don’t worry about it.” Not fun to deal with, but it is what it is. Yoga usually does the trick.

I could write in elaborate detail about instances of these emotions, which are far more complicated than what I’ve described. They’re worth more than just a paragraph of detail. But I’ve found a lot of people along my journey haven’t gotten an explanation of emotions beyond a normative way of experiencing anger. Emotions can be standalone, but they also live in context. This is not a simple terrain to navigate.

What has helped me, and continues to help me, map out my emotions are three main things: Talking with people I trust, journaling, and drawing. Art is such a wonderful medium for exploring one’s mind, especially because its metaphoric quality is so fruitful in exploring emotions. Of course this must be done safely, especially since anger can be a destructive emotion — and when it feels like that to me, I’ll play video games or exercise. But when done with care, examining anger can wield very significant results.

Dealing with the Shame of Mental Illness (or Not)

Shame is a very difficult concept to navigate. Its role in mental illness is different for every person. One of the first ideas I want to point out is that not everyone feels shame related to their mental illness. After being asked this question many times — specifically for advice — I thought it was about time I wrote about it. The quick version is I did feel ashamed of myself because I had a diagnosis of bipolar, but I don’t feel ashamed of myself anymore. Though I may have my moments of self-doubt, I’m proud of who I am.

Shame and pride are complex experiences; they’re not just emotions, but incorporate behavioural and cognitive aspects. I used to work in the lab of Dr. Jessica Tracy, who is a known scholar for the study of pride (and also on shame, which I worked on in my undergrad). In research, I often see shame subsumed under stigma, which is unfortunate. Shame is not necessarily a part of stigma. It’s kind of like saying stigma is this nicely gift-wrapped box handed out as a party favour to every person who finds themselves with a diagnosis. An example of this that ties into these concepts is self-stigma; in particular, it is the idea that self-stigma is not just feeling depressed, but can manifest as an energizing anger or just nonchalance (great open access article here).

I can certainly attest to being absolutely furious in the months following my diagnosis (for many a reason). I also acknowledge the deep depression I was experiencing and how that was affecting how I viewed myself and the world. Nowadays, I don’t give the idea of shame much thought because it’s not really part of my mental illness experience anymore. But acknowledging this is a very real experience for many, I’ll attempt to give some advice. So take it or leave it, but know that shame is transient and can be resolved.

Dealing with Mental Illness Shame

No, there is no step-by-step process. There is no guidebook, no easy way to dispose of shame. It takes time to grapple with this concept. It takes a willingness to face parts of yourself that you don’t want to see. Dealing with shame means confronting life as you live it and acknowledging it may not just be something you’re feeling. Is there a place you frequent that makes you feel shame? Are people around you contributing to your shame (be it good or bad)? Shame can be a monster squeezing you until you cry or can’t breathe. It can also be a comfortable, but old jacket that you’re scared to take off. It takes many shapes and forms. My foremost recommendation is therapy. Find someone skilled at holding your hand as you face your shame. You don’t need to, and probably shouldn’t, do it alone. This is especially true if shame is disrupting your ability to perform day-to-day actions.

 Is shame part of your lifestyle?

What does shame make you do? What does shame make you think? Or rather, how are you letting shame dictate your life? What percentage of your thoughts sound like shame? Are you harming yourself (mentally or even physically) because you feel shame? Is shame silencing other parts of your thoughts that you want to talk about? There is a myriad of questions I could list. I share them as a way to start thinking about shame. A technique that can be used to deal with shame is journaling. Whether it’s traditional diary-style or a concept map or even sketching and notes, this can be immensely therapeutic. The combination of therapy and journaling has helped me immensely throughout my mental illness journey. Mapping out which areas of your life shame affects can help you begin to say, “Okay, here’s where I need to start dealing with shame.”

Contribute to a Caring Community

While it’s easier said than done (especially if shame is getting in the way), a large part of help I received was simply by talking to other people who shared my experiences. So I asked a friend of mine to elucidate this concept by sharing her experience:

When I was first diagnosed with bipolar disorder type 1, it was really validating; mind you, I was diagnosed while I was in the highest mania I’d ever experienced, and barely anything affected me negatively at that time. The medication I was first prescribed didn’t do anything to abate the symptoms of mania, and I was also experiencing psychosis, which wasn’t initially diagnosed with the bipolar. When I was prescribed a medication that worked, however, the dreamy world of psychosis faded away, and my mood switched over to depression, accompanied by the notorious feelings of guilt, shame, and humiliation which flooded my every waking moment. It wasn’t until about 2 years later, after I had tried all kinds of medications, that I sought out support groups, and the shame finally started to abate. I also joined a speaker’s bureau and publicly shared my experience with bipolar and psychosis. This was absolutely the last thing I wanted to do when I was first diagnosed, but speaking about my illness with strangers, and talking to members of the audiences really opened my eyes as to just how common mental health issues are. There are so many people out there who are wanting to talk about mental illness, but who feel silenced by the stigma that surrounds it. The validation I received from speaking publicly has empowered me to move forward in my life and to not let my label hold me back from achieving my goals. -Tracy W.

Tracy brings up a great point that I think has helped me the most. Talking about my experiences to strangers has empowered me in my mental illness journey.

Labels, Labels, Labels

It also took me a couple years to work this stuff out, so buckle up because it will most likely be a time-consuming ride. Eventually what I realized is my shame was tied to the label “bipolar disorder”. This is a more complex section of this topic because it also ties into identity and how I came to understand shame in relation to my bipolar. I’m in the process of forming a new relationship with the word “bipolar”, which may sound a bit odd but it’s the stage I’m at with myself. Some people have said to me before, “How can you possibly be grateful for a bipolar disorder diagnosis?” I used to want to get rid of my bipolar more than anything in the world. Now, I celebrate having bipolar. It’s not like I want an illness, but it’s a part of me and I love who I am. It can be both beautiful and destructive, both expansive and chaotic.

Bipolar disorder has taken lives and created suffering for many. I respect that people don’t view it the way I do, especially since I was given the label in a time when I can speak out about it without consequences. I encourage critical thinking about emotions in not just their emotional senses, but behaviourally and cognitively as well. I hope some of this helps in the swamp that can be shame.


How do you deal with shame? I’d love to hear from you!

Rumination: Ain’t Nobody Got Time for That

So, shower thought (literally): Do I even have time to ruminate?

It was a Sunday night and I was vaguely tired after yoga. Yet, I still had a book to finish, a paper to review, and research to read for class. As I geared up with a cozy blanket in my papasan chair, I thought about the negative thoughts swirling in my head after taking a shower. I’ve always had body image issues, despite being quite active for most of my life. I was noticing familiar phrases floating through my mind:

Look at all that fat. See how much I can pinch there? Work harder, lose more weight. I’m ugly.

All these concepts surrounded me as I picked up my book Under the Bridge: The True Story of the Murder of Reena Virk. (Not exactly great bedtime reading, but that’s what happens when you take a course on school violence.) Suddenly a different thought interjected my stream of degradation:

Wait. I don’t have time to ruminate. I’ve got shit to do.

For some reason that clicked for me, and it’s got me wondering: Can negative rumination be turned off just like that? Is it just distraction, or does it really go away? And over time, will negative rumination disappear? Food for thought, indeed. This common symptom of depression (and other states of being) is a hard habit to break, if it can even be broken at all. For me, I never realized I had been ruminating for most of my life until someone pointed it out and told me I ought to stop. Yes, I’ll just try to be less depressed. I never saw negative rumination as a choice. (As an aside, positive rumination is also a thing.)

What I wonder about now is my participation in rumination. I mean, it’s me, right? Presumably, I’m the one thinking my thoughts. Of course, I recognize the diversity of experiences in the realm of thoughts. But I am an active participant in my thoughts. It’s a behaviour I can default on because I learned it before I learned other ways of coping with my personal negativity. So for those of you who resonate with where this is going, allow me to offer some tips on what’s helped me be more mindful of my rumination.

So you want to ruminate less?

What works for me will not work for everyone, or even anyone at all. At the very least, I hope it can inspire other creative ways to manage rumination — which, I’ve come to believe, can be managed very effectively. I’m not going to say rumination needs to be exiled from the brain; perhaps there are lessons to be learned from rumination, and thus I leave that open for interpretation.

Good Ol’ Mindfulness

Yeah, we’ve heard this one before. I used to be against the concept of mindfulness, calling it “impossible” because my brain just doesn’t do life that way. Slowly I came to realize that one of my largest personality traits, that of a stubborn individual, was inhibiting a healthier me. So I said, Okay, let’s try this mindfulness thing out — textbook style. I’m a bit of a rebel (cue friends “yeah, you don’t say”), so I think I was just being difficult because mindfulness is preached almost like a religion (and rebels obviously don’t need that). It still pains me to say mindfulness works for a brain that is perpetually slammed with thoughts 24/7. Take a look at this Tedx talk:

“Having a different relationship with sadness” is a wonderful idea. Mindfulness can help understand oneself and why negative rumination exists in oneself. The worst side effect of mindfulness is taking care of oneself. Terrible, I know.

Prove your ruminations wrong.

So I have what seems like a constant flow of body image issues in my mind. Take this thought, for example: I’m not skinny enough. Often rational thoughts don’t work on irrational thoughts, but any effort to decrease negative rumination is time well spent. So my process for proving my thoughts wrong goes kind of like this:

“I feel like I’m not skinny enough.” Well, I know that’s a reflection of beauty standards that change over time (neat video example here). So that means my feelings are based on what society considers beautiful. Also, I work out 4-5 days a week. Objectively, I’m in the healthy range of height to weight ratio. I know that bone structure and fat deposition varies immensely from person to person, and that “skinny” is a very vague term. If my body type, as it is now, was on every magazine, I’d be feeling pretty good about myself. So maybe what I’m feeling is more of a visceral insecurity about my body that I’ve had for a long time (maybe one that many women share in Western society).

At this point, I might still feel shitty, but at least it gets me thinking about why I have this thought loop in my head. And I have evidence to the contrary; even if I don’t believe it, that doesn’t invalidate my evidence which is based in an arguably more objective reality. And with this information, I can take steps to counteract my negative rumination cycles. For instance, I can add an extra day of cardio, I can reduce the amount of sugar in my diet, I can limit my exposure to the media, etc. That may not make the thoughts go away, but it means I’m putting effort into saying “no” to that negativity.

Distraction… does it work?

Sometimes I find the emotions attached to my thoughts (or even the thoughts themselves) too overwhelming to deal with. I need to know when to take a step back and when to distance myself from these thoughts. It’s not realistic, and perhaps not even healthy, to always dive straight into these ruminations and navigate them as soon as they come up. Perhaps, one day, that may be accessible for me. But right now, sometimes all I can do is immerse myself in a gripping novel or play a video game — anything to disconnect me temporarily from the intensity of my brain. When I feel calm and when the time is safe, I can go back and look at my ruminations.

Building that relationship with the self…

I believe the foundation of my mental health is built on my relationship with myself. When I know why I find myself “stuck” in thoughts, I can: 1) empathise with myself and 2) work with myself to stop the pattern of negative thinking. This is not an overnight process. I still find myself ruminating from time to time. But the more I get to know me, the more I find I can steer myself in a positive direction. Some other considerations:

  • This is not a method I have used in depressions when I’ve been suicidal. That requires professional help.
  • This is not a method I have used in hypo/mania. That’s a whole bag of goodies of a topic on its own. (Positive rumination, perhaps.)
  • I had to find “stability” in my life before I could tackle this appropriately. I have to figure out, with the help of professionals and loved ones, when I can do this on my own and when I need to seek help.

I’m in a good place in my life. Sometimes I have symptoms and feel the pull either down or up, but I take very good care of myself. So maybe this resonates with others and maybe it doesn’t. At the end of the day, all I hope to do is provide a sounding board for those in need of support.

Psychiatrists Are Not Your Enemy

Medications, side effects, and a plethora of negative feelings (pick your flavour)… these are the things that have been associated with psychiatry. Only a quick perusal of the internet will tell you how people feel about psychiatry, and their experiences with particularly — how should I say this? — dislikeable psychiatrists. I’ve seen both extremes of this situation. I once had a psychiatrist who asked me if my menstrual cycle was causing my bipolar (Because why not? Well, I can think of several reasons…). But I also have a really great psychiatrist right now who I feel comfortable with saying just about anything. It’s important to remember psychiatrists are humans, and one experience with one human does not make all humans terrible (or good). Before we begin:

You deserve to have the best quality of care. You deserve the have the best quality of care. You deserve to have the best quality of care.

I acknowledge there are many barriers to getting a good psychiatrist (it took me a while). Sometimes people are stuck with what they get, be it because there are no other psychiatrists available or whatever social/economic reason ails people. As I write this, note that I live in Canada; in British Columbia (BC), where I live, psychiatrists are covered by our provincial health care plan and thus I do not have to pay for one. This is a privilege I am very aware of and very grateful for. When understanding what psychiatry has to offer, it is crucial to understand the cultural condition in which psychiatry exists.

Some Factors Influencing Psychiatry

Medical Training: Care is not taught equally. The roots of a good psychiatrist start early — I would argue before that application to medical school as someone who studies educational psychology. Though I am not intimately familiar with medical school, I know through certain mental health activist efforts that the care of medical students is not that great. Psychiatrists — you know, being human and all — need to be supported in their practice. If this idea of care is not interwoven into medical training — which, I hear, it is beginning to be — then what can we assume? Is it fair to expect a psychiatrist who has never been formally taught compassion and empathy (which can be taught) to be compassionate and empathic?

Workplace Support: In BC, there are different settings a psychiatrist works in — from hospitals to outpatient centres to private practice. Now, imagine your job or a previous job in which you felt you had no support. How did that affect how you do your job? I know when I’m working in an environment that offers lots of hugs and chocolate, I try my best to go above and beyond my job duties. But, in the past I’ve had bosses that I’ve felt fear working under — and boy, let me tell you, I stopped giving a shit really quickly. The workplace environment is important for us all, so we should consider that when understanding why psychiatrists practice the way they do. Do they feel supported in their workplaces?

Pharmacology and Theory: Here we go, the other big “P” word. I’ve yet to meet someone who hasn’t had a bad experience with medications, and so many of us have grown weary of pharmacology after trial and error with so many drugs. What I’ve always wondered, having worked with psychiatrist-researchers, is how the field of pharmacology influences the way psychiatrists practice. We’ve all heard the stories of doctors being bought by certain drug companies to sell this and that product. But there’s the flipside; what about the psychiatrists who are under that pressure but trying to resist it? When it’s a primary responsibility to manage a patient’s psychotropics, I think this is something we could all understand a little better. Psychiatrists do have preferences for which medications they prescribe. From my personal experience, it’s had a lot to do with what theoretical orientations psychiatrists have regarding the causes of illness. Ask your doctor today what her/his theoretical orientation is.

Takeaway: Psychiatrists aren’t evil doctors trying to make us zombies reliant on big pharma. They’re people. Some are good, some are okay, some are not quite there yet, and for some we miss appointments intentionally. Many factors influence how psychiatrists care for their patients.

A problem with this section of my writing this that is super important: I didn’t ask a psychiatrist to help me write this. I’ve made a lot of assumptions and it’s no different than when psychiatrists make assumptions about their patients.

Being a Self-Advocate In a Psychiatrist Appointment

One of the most difficult tasks I’ve had to do in a psychiatrist appointment is say “no, this is what I want instead”. I’ll share some of my tips, but I know there are others out there.

  • Have a support blanket in place. These can be very scary experiences, and I think it’s important to do some prep work with people who support you before you go into that appointment. I also think it’s good to have those people available for you after that appointment no matter the outcome. Peer support groups are great for this.
  • Prepare what you need to say. You can almost think of it like preparing for a speech or a debate. Do your research. Know what you need to say and what points you need to get across. You can even write a letter to read out loud if memory fails, or have notecards with bullet points on them.
  • Know your next step. If you get what you want, awesome! If you don’t, there’s always something you can do. Hospitals in BC have complaint processes that can be conducted by the patient or someone the patient knows. There are walk-in clinics that can offer medication support if you want to drop your psychiatrist and find someone else (or you can just find a family doctor and work with them exclusively). It’s important to know what your rights are as a person with a mental illness.

Takeaway: There are tools and techniques you can use to advocate for yourself when under the care of a psychiatrist. It may feel hopeless at times, but know that there is hope and you deserve to be treated well.

Finding Self-Esteem in the Manic Self

Self-esteem and the “self” are both very messy concepts in that they can be hard to define theoretically and vary immensely from person to person. One idea I want to suggest in this article is how experiences in mania can be extracted into everyday life to help build confidence and help with insecurities we may have as people living in this world. Of course, all manic episodes are unique and this article is geared toward those who have had manias where the inflated self-esteem has been felt with positive intensity. I have had this euphoric kind of mania where I felt indestructible and my social anxiety was completely nonexistent. Hopefully some of my insights from those moments of my life will be helpful to some.

The first thing I had to do was make peace with what happened in my mania. There were positives, but there were also negatives. One of the positives was being uninhibited in social situations, but the negative side of that was a risky sexual escapade. The negative side of mania can haunt us, and some parts of what I did still do. But my philosophy in life is that every traumatic experience has a silver lining — many might not believe this, but I do. My silver lining in this particular situation is this: Even though I was manic, that was still me. That self-esteem exists inside me — the mania just brought it to an extreme.

Inflated self-esteem means that self-esteem exists despite being a symptom of mania. In the aftermath of mania, it can be hard to find the positives of those experiences (if there are any) and I know I certainly wanted to put as much distance between my manic self and my “normal” self as I could. But as time has gone on, I’ve realized the potential of reawakening that self-esteem in a healthy way. It was almost spiritual in nature, but connecting with that reality, that manic self, while in a stable mindset allowed me to understand how self-esteem operates in me.

Figuring out the narrative of my mania helped empower me to take ownership over my self-esteem. Noting how fluid self-esteem is in me made me realize that I could use that to my advantage. Knowing that I had already captured self-esteem made me wonder if I could capture it again in more contained environment. It took quite some time, but eventually I gained confidence and respect for myself by knowing I already have that inside me.

Mania can be utilized as a tool for self-discovery and empowerment. It’s not a philosophy for everyone, nor do I mean to say this is an easy process — it isn’t. Delving into the depths of my mania has been facing the most disturbing parts of me at some points. But I really enjoy that, which is probably pretty weird but weird is what I do. It gives me say over what experiences influence me and gives me control to be the me I want to be. A lot of how I did this was by using mantras and testing reality by putting myself in situations where self-esteem can be fostered safely. One example of this is finding the confidence to wear blue lipstick  — yeah, I’m that kind of weird. But hey, it worked. It was terrifying at first, but it worked because I knew I already had self-esteem; I just had to find it again.

This is not a road to walk alone. I’m a firm believer that having a support network of loved ones and health care providers is necessary to provide a safe space for people to begin asking these questions of themselves; it can bring up a lot of emotional distress and it’s important to have support for that. Again, this is not meant to be a doctrine to follow, but it’s a perspective I can share that has been very helpful for me — hopefully it will be for someone else out there as well.