Common Things I Hear as Someone Who Has Bipolar

It’s been about three years since the inception of “Redefining Bipolar” and everything that coincided with the creation of this website. I’ve done many speaking engagements, a lot of questioning and answering, and generally being out and about as someone who lives with mental illness. So over the past few years, there are some common questions and remarks people have posed to me; I thought it might be neat to put a few down in a post for some weekend food for thought. Let’s dive right in with the big one:

“You’re so brave.”

To see gratitude in someone’s eyes and hear it in their words warms my heart. I don’t mean to take away from that sentiment, as it is indeed something I respect and find comforting to see in others. What I do want to add is my thoughts on this phrase and how I view myself in relation to it. The concept of being “brave” doesn’t resonate with me as much as other adjectives might. Part of the definition of brave does include facing danger or pain; when I do public speaking, I’m not putting myself in a position that would cause me pain. I’ve never had any negative repercussions from being public about my bipolar. I have privileges in life that secure my position in it, such as being an academic and having a safety net of people who could rush to my aide at any sign of structural or social threat. I certainly didn’t always have this, so being “brave” was at some point relevant. But it’s not anymore. I’m not brave. In an abstract way, I’m basically just secured and insured to some degree. I enjoy public speaking immensely and I have privileges others in my position don’t always have. No, it’s not without risk — but the risk is much smaller to me than it is for others. So I see this as a moral obligation. At one presentation I had recently, someone in the audience asked me why I am so open when I speak. My answer was simple: Someone has to, and I seem to have the skills to do so.

“What can I do to help my friend/colleague/etc. who has bipolar?”

When people ask me this question, I understand where they’re coming from. But, what always goes through my mind is, “Well, I don’t know — who are they?” While there are some general skills that you can use to navigate the realm of bipolar — like active listening and generally being empathic — every person is different. It’s also a loaded question, because what exactly does that person need help with? Or do they even need help at all? Even with my having bipolar, I still need to be mindful that I’m not seeing problems that don’t exist in my friends who also have bipolar. But, there’s a simple solution here: Talk to the person and see if they need help. Engage in a dialogue while being mindful of emotional boundaries.

This is more nuanced in situations where symptoms may be appearing or escalating quickly. Depending on who you are in that person’s life, it may not be appropriate to intervene even if your intentions are good. For myself, I wouldn’t want anyone helping me unless we have an existing relationship where we’ve talked about my bipolar and that person’s role in my life. There are some people I wouldn’t want helping me under any circumstances, and there are specific people in my life who know how to help me in all the different emotional/cognitive/behavioural states I can be in. I can’t speak for anyone but myself, so my best answer for this is always to talk with that person and get to know them — you know, as a person, not just someone who has bipolar.

I have a draft I’ve been working on for a long time about helping someone with bipolar, so when that’s finally done I’ll link it here.

Scenario: Self-validating audience members.

This is a particularly interesting phenomenon to observe as a speaker. I’ve gone to many events where there’s a q&a portion of the presentation, and sometimes the following happens: Someone asks a question to confirm something about bipolar that they really need to have confirmed. For example, take someone who asks a question about the genetics of bipolar. I’ll explain that studies have shown it can run in families, but we don’t have the knowledge about genetics to point to any causal relationship, and there are still many psychosocial factors to analyze. And yet said person will respond with something like, “I knew it was a biological condition.” These self-confirming biases are predominant in society, so it’s not a surprising scenario to run into.

What makes me so curious about these situations, though, is what’s going on in that person’s life that they’re so badly looking for answers. Sometimes I get the opportunity to follow up with people after the presentation, as I find many people get some sort of relief by expressing their circumstances. For me it brings up the ache of knowing I could whip out resource after resource and sometimes it’s just not about knowledge. Sometimes I listen to people and there’s such pain in their hearts that’s leaking out. It’s difficult knowing all I can do is listen, but I hope it does help in some capacity. Speaking of being brave — to me it’s the audience members who often hold this quality. Since it is a stigmatized topic, it’s not always easy showing up in a room full of strangers not knowing what to expect.

So those are some thoughts for now.

If you have any questions, there’s now an option to ask anonymously! Just look at the navigation bar for ways to contact me. I’m happy to answer anything.

 

13 Reasons Why: When Research and Lived Experience Mix

Trigger warning for suicide, sexual assault, bullying, and spoilers galore. One thing I also want to begin with is that it’s taken me over a month to write this article, as I was patiently waiting for others to respond to this show and observe how everyone has been reacting.

There has been a great amount of controversy surrounding the Netflix TV series 13 Reasons Why since the show was released. There was some chatter on my facebook feed about the show being extremely insensitive to mental illness, so of course I had to watch the show to see what all the fuss was about. Little did I know I would end up watching a show that not only feels like parts of my own life, but actually has a solid foundation on research. Initially, I thought I would be critiquing the hell out of 13 Reasons Why, but I’m genuinely blown away by how realistic the show is. I’m happy to announce I even took notes while I watched it; this is key because there are some extremely significant trinkets that you could miss if you’re not paying attention or don’t know what you’re looking for. Instead what I’m finding is critiquing the people who have/have not watched it.

So let’s talk about bullying.

Many focus their arguments about this show on suicide and mental health. While I agree, there is a HUGE lack of conversation about bullying and how it has the biggest role in this story.

I recently finished a doctoral seminar on school violence, and I found myself wishing this show had been available earlier so I could have discussed it in that seminar. The Handbook of School Violence and School Safety: International Research and Practice is where I’m mostly drawing my arguments from, just so it’s clear that I’m not pulling facts out of the air. Though I haven’t read the entire tome that is that book, I had the chance to research scenarios like Hannah’s to figure out what exactly goes on in situations like hers. The short of this is Hannah’s situation is a sad reality many have endured and continue to endure.

The one thing that stuck with me throughout the show is how teenagers will not break their code of silence. I made some comparisons to real life cases like Reena Virk and Amanda Todd. In looking at instances like Reena Virk, who was brutally murdered by her peers, it took well over a week for anyone to come out with information regarding her disappearance, despite most people knowing what had happened under the bridge that night. This is a toxic problem that researchers, teachers, administrators, and parents alike have all tried to get around. It’s even more intriguing in Hannah’s case because of the tapes she made that essentially indicted those she felt had wronged her. But the fact that those who received the tapes did not pass them onto adults (except for Tony and Clay at the very end, weeks after the fact) goes to show that this code is held in high regard and mirrors real life instances. While Reena Virk’s case wasn’t about suicide, it still elucidates important aspects of the influence of peers in Hannah’s life.

There were several “gems” in 13 Reasons Why that told me a greater story of what Hannah had experienced beyond what her tapes were saying. In a later episode, her parents are talking about their failing business and her mother gets the idea that they should move “again;” in one sentence she glosses over the fact that Hannah had been bullied by “vicious” girls at her previous school. This is similar to Amanda Todd’s story, in which she went from school to school to escape bullying without reprieve. Sometimes moving schools can help the victims of bullying start anew, but often patterns repeat themselves for various reasons. In Amanda Todd’s case, it was because of her cyberbully and other in-person bullies continuing the legacy at her new schools. It was one sentence in the show, but it is a large piece of Hannah’s story that we don’t see despite its significance. Amanda Todd ended up taking her life, and she made a video online documenting it. Is that different than tapes? I would be interested to know what Amanda Todd’s family thinks of the show.

Many have mentioned that Hannah was not only bullied, but became a bully via her tapes. I thought about this for a while and I lean in the direction of addressing the tapes as a suicide note. Can one posthumously bully others? Definitions of bullying always include the bully having perceived power or status over the victims, and this is not the case for Hannah when she is alive. If we are to think of the tapes as bullies, as having power over those being bullied, then I think we’re missing the point. The tapes are Hannah’s story of how she was bullied, raped, her feelings about her interactions with others, and her deep depression. By conventional definitions of bullying, this is just the story of a victim. If anyone is the bully in the scenario, it would be Tony because he enforces everyone to listen to the tapes; he especially holds Clay responsible, but at the same time Tony is emotionally supportive for him. In other words, not technically a bully.

This leads into the idea that those on the tapes will be “exposed” if they do not listen to them and pass them on. I fail to see the victimization in this scenario considering the tapes are addressing what all the teenagers (and school counsellor) actually did. It’s merely holding them accountable for their actions. What’s interesting and accurate here is how every teenager is thinking about the consequences of him/herself being exposed and not holding a greater sense of right and wrong in the world. This is in line with various theories of moral development, of how teenagers in Western society are biased to think in terms of how events relate to themselves alone. Only a couple of them, at the end, want to come forward with the information after weeks of struggling with keeping it a secret and saving face. Ultimately, some of them want to honour Hannah by outing Bryce as a rapist (and bully) and making amends for the perceived wrongs they did not only to Hannah but to others around them.

13 Reasons Why is only partially about suicide.

The claim that it glamorizes or romanticizes suicide seems to me to be a coverup for how uncomfortable the suicide scene at the end is. Hannah, the protagonist who kills herself and whom the stories surround themselves around, slits her arms in a bathtub. Many people have made a good point in noting that these scenes should be uncomfortable. If watching someone die is ever comfortable, it’s time to get a mental health assessment (and this applies to all film and TV, so think about that too while we’re at it).

There are also claims that this is a “revenge” suicide. If she didn’t hate everyone who bullied her and the men who sexually objectified her and raped her, then I’d be concerned. But she didn’t kill herself because she wanted them to suffer. She killed herself because she was suffering. This is notable in her anonymous letter she wrote in her communications class, in her discussions with the school counsellor, and in other what we call “micro” aggressions between her and her peers. She was severely depressed and suicidal and she didn’t have to say it. Calling it a revenge suicide only stigmatizes someone who is hurting in many deep ways. But more on that later.

To bring the focus back to bullying, there’s a scene earlier on in the series during their communications class where the teacher brings up the idea of “social learning theory.” I think this should actually be social learning theories as more of a blanket term, but it was Albert Bandura who came up with social learning theory in the 80s. Albert Bandura is a social psychologist and is famous for his work in understanding behaviour — and aggression specifically — in a social context. It’s one of those gems I mentioned earlier, because it’s said in one sentence and yet it is critical in understanding this TV show. I’d even go as far to say as the writers may have intended it to be the foundation on which to set the plot and its characters. It’s one theory that tries to explain the very plot we’re presented with in 13 Reasons Why.

From a Film Perspective

A lovely article by the CBC points out the myriad of issues I’d also like to address, but one point in particular stands out about the nature of filmmaking. It reads, “The main character is able to make her voice heard after she’s dead…” which brings up some food for thought: Does the show have reliable narrators? The concept of “reliable” refers to characters who may or may not be telling you the whole story, or may be misleading the audience. In a meta sense, this also reflects the reality of teenage bullying; the truth is hard to find, with multiple versions always coming to the forefront. We see the show mostly through Clay’s listening to the tapes. Even though we hear Hannah’s voice as a narration, it’s still Clay’s perspective. Is he omitting or emphasizing parts of the tapes?

Logistically, cassette tapes can play 30-120 minutes to content per side. In the show we see that every tape is played through in its entirety on each side; this means that there is potentially 60-240 minutes of content of Hannah’s story per 50 minute episode. Because the show isn’t just Hannah’s voice all the time, it’s reasonable to conclude that Clay is cherry picking information that is significant to him. As an audience, we’re probably hearing only key points that Clay thinks are important. This is a critical facet of the show to consider, especially given the third person omniscient voice. Who is really telling the story?

After my analysis of the show, I feel bad for the filmmakers who obviously put a lot of thought into crafting the story. No, this story doesn’t follow mental health 101 — that’s not the point. So this leads us to the question of social responsibility on the part of the filmmakers. Was it a good idea to make this TV show? That there seems to be a split between people who think 13 Reasons Why is damaging and those who relate to the story because it actually happens makes me say yes — we need to be having this conversation, and the story of 13 Reasons Why has been a vessel for this topic. We need to remember that 13 Reasons Why is a drama; we can’t confuse the distinct goals of the art of storytelling with formal education.

The fuss about this show makes less and less sense considering how many other films and TV shows have portrayed mental health. Just the other day I watched a new release called Lights Out where the mother ends up shooting herself in the head to make the plot go away; it was her fault because she didn’t take her meds and invited her evil psych ward friend into her head. It used mental illness as a spectacle plot device. But no one’s complaining about that. Why? If the sole argument against 13 Reasons Why is its lack of social responsibility in portraying mental health then we’re severely misleading ourselves. For example, one of the most famous horror movies is called “Psycho.” Compared to most other film and TV, 13 Reasons Why is setting a higher standard for the rest of the industry to follow.

Suicide Contagion

Yes, it exists, but research suggests it exists primarily for people who are considered “at risk,” which is a debated term on its own with a history in several disciplines. Further, there’s no causal relationship between having a peer kill themselves and other people then taking their own lives. Suicide contagion studies are all correlational and fraught with measurement problems, such as the problems researchers encounter with self-reporting questionnaires. Also, the contexts in which this research is done varies immensely, from celebrity deaths to news articles — and context is key because otherwise generalizability can be called into question. A more recent article noted “suicide contagion” as an entire concept needs to be clarified. The best way to know if 13 Reasons Why does produce a suicide contagion effect would be to study those who watched it and see if suicide rates go up. And it would have to control for many, many other factors — such as school climate, parental warmth, community safety, preexisting conditions (not just mental illness), and so forth. We need to proceed with a healthy dose of skepticism on this issue.

Also in the aforementioned CBC article…

The show has a TV-MA rating (may not be suitable for those under 17) and provides a warning to viewers before the episodes with particularly graphic content.

Yup, there are trigger warnings. If suicide, bullying, and sexual assault are triggering, it’s up to the viewer to know where to draw the line.

“I think it’s showing, like, what’s really going on out there in the high school world and it wants to show us we shouldn’t treat others like that,” 15-year-old student Ashley Rosales told CBC News, sitting with six other friends at a Los Angeles mall, all of whom watch the show.

Because as I’ve stated, this is indeed a reality for many.

 “The series is very intense and romanticizes the story of Hannah and her suicide.”

How? I’m now accepting evidence-based answers.

Many schools in Canada —including in Ottawa and around B.C.— have since sent out their own advisements to parents. One Edmonton elementary school has prohibited students from talking about 13 Reasons Why on school grounds.

The most dangerous part of this entire argument is NOT talking about it. In all the suicide training I’ve taken in my life, this is the exact opposite of what you’re supposed to do. As someone who has talked strangers down from suicide and who has taken people to the ER when they’ve been suicidal, you NEED to talk about suicide as directly as possible. This feeds into the stigma that talking about it only makes people want to kill themselves more. Not talking about it is one reason why suicide is a public health issue.

“Adults are portrayed almost across the board as being disengaged, uninformed and almost uncaring and, therefore, not a source of help or support around any of these issues,” she said. “It sends a message ‘you’re in this on your own.’ The adults can’t help you.”

Yeah, that was my reality as a teenager. And many teenagers don’t see adults as people they can trust and go to for support. On the topic of suicide, many adults are uninformed. Ask yourself if you’d know what to do if a teenager told you they were suicidal. You can have all the knowledge in the world about suicide; when someone comes to you actively suicidal, there are just some things you can’t anticipate without having already been there either yourself or with someone else.

Helen Hsu, a clinical psychologist in Fremont, Calif., whose work involves suicide prevention in schools, helped shape some of the 13 Reasons Why scripts. She said not showing Hannah’s suicide would be almost “coy and avoidant” and that medical studies aren’t definitive about the risks of suicide contagion.

See my previous notes on the problems of suicide contagion research.

“The more I think I have a picture of that person, the greater the chance that there’s going to be this connection and imitative behaviour,” he said, citing research from world-renowned suicide contagion expert Madelyn Gould. “We know that this contagion effect exists.”

That cited research isn’t bad research — citing social learning often — but it has its drawbacks. When there seems to be an instance of suicide contagion, it’s important to look beyond the individuals. It would be more accurate, in these instances, to take a bioecological perspective that accounts for social learning, but also for an individual’s ecology (community, home life, cultural norms, history over time, etc.). Again, see my previous comments.

What others have had to say…

I’ve read a mix of opinions and the ones that bother me the most are those that argue against the show while either not having seen the show or not giving reasons as to how it’s detrimental to various aspects of mental illness. One article mentioned thinking the show isn’t “safe” for anyone who has a mental illness, despite some not overtly dealing with mental illness themselves. This is a concerning perspective for me because it taps into the idea of being what I call a misleading advocate; in a way, it’s being offended for people and offering advice that is not informed by lived experience. After my critique, I would strongly recommend that people without that lived experience do watch this show because it can help them understand the reality many people have experienced. While of course trigger warnings are needed, they are indeed provided. I question if this idea of not being “safe” actually means avoiding content that is uncomfortable. Suicide is not a comfortable topic and 13 Reasons Why can be a tool to help us become more comfortable with the subject.

Another article grievously misunderstands the “takeaway” message of the show. The author says the tapes are meant as revenge to inflict on those around her — the “causes” of her suicide. Suicide is a multifaceted issue, but there are certainly events that can be the tipping point. I can definitely point out several people who were the reasons why I tried to kill myself. My high school counsellor was useless; she even told me that I would never make it to a four-year university. So “in reality,” as the article makes a point of describing, what happens in 13 Reasons Why are situations that do in fact happen. It’s literally reality for some people. No, it doesn’t have a happy ending and it doesn’t provide any resources for people struggling — that’s not its purpose. It’s a TV show, not a educational video. The art of film depicts the world and a story in novel ways, and it did just that. It’s our job to be critical consumers and to think more carefully about what is being shown to us and what goes into the making of media. I will say that I’m glad the show has sparked controversy because we do need to start understanding suicide as a multifaceted, multi-causal issue.

One of the writers of the show spoke out about why various aspects of the show were displayed as such. He used his own suicide attempt and others’ to help craft the scene in which Hannah kills herself. The best thing we can ask for in TV and film is having it co-written by people with lived experience of the issues being handled. When people say 13 Reasons Why glamorizes suicide, I always ask “how?” and never seem to get a concrete answer other than “it shows a suicide scene.” When a suicide scene is written by people who have tried to kill themselves, that’s not romanticizing — that’s reality. He even alludes to why tapes were included as a means of storytelling and how showing the suicide scene allows us to break down myths surrounding it. I agree; part of destigmatizing suicide is dealing with how raw that act is. I can’t emphasize enough how much I related to that scene and how close I came to becoming Hannah. It was certainly uncomfortable to watch, but that’s the point. If we truly want to help people and understand suicide, we have to face it in its raw form. This is, in part, why peer support is so effective; speaking to someone who “gets it” is extremely validating and can be that lifeline that people like me sometimes need. Suicide trainings like ASIST echo the sentiment of needing to be more comfortable with suicide through exposure to it.

A registered nurse and professor spoke out about the show in suggesting that we use it as an educational opportunity. This nurse brings up two interesting points: 1) The push for mental health literacy starting with young children has sparked the same concern about “promoting” suicide, and 2) the suicide scene (and others in the show) are no more graphic than other shows. I hadn’t thought of that in my initial reaction, but it’s a really good point. If seeing Hannah cutting her own wrists is too “graphic,” then there are entire genres of film and TV that are far, far worse. It again speaks to the autonomy of the audience to decide what they can and cannot handle in a movie and parental discretion/guidance in allowing minors to watch graphic content. After all, it’s practical makeup effects, just like any other movie. As real as that can look, it’s still just makeup.

Yes, teenagers will get their hands on this and it’s not something we can control. But if that’s the argument we want to tackle, then what about things like online pro self-harm communities? Compared to a show that’s available on Netflix, there are far more disturbing and damaging online phenomena that deserve much more attention than a mainstream TV show.

The Irony Behind My Dissent

Many people critique the show via Hannah’s suicide and how she went about it. Let’s think about this: Are we blaming her for killing herself? It’s what one CBC opinion article seems to suggest by saying it “normalizes suicide” and saying it’s unfair to say others contributed to someone’s suicide. But by doing this, we’re simply perpetuating the stigma that suicide is a selfish act. By claiming that Hannah’s tapes were part of her “revenge” suicide plan, we fail to see them as her suicide note and disrespect her story in its entirety (if we are actually exposed to a reliable narrator).

At the end of the show, many of the teenagers in the tapes acknowledge the stories as true. Think about how many teenagers were bullied that ended up killing themselves. I was almost one of them; I wrote about how much pain my bullies had caused me, listing their names and their wrongdoings in the journal I kept at the time. If I had succeeded in taking my own life, someone would have found that journal. I probably would have made sure someone did. Would you call that a revenge suicide? Or would you look more closely and understand it was merely a byproduct of the immense pain and suffering I was failing to fight? Note failed suicide. I could have been Hannah.

Don’t blame Hannah for wanting the truth behind her death to be known. Don’t insist that suicide is always the person’s action that has nothing to do with social circumstances. See 13 Reasons Why as something that has happened and will continue to happen until we start looking at suicide from other perspectives. Better yet, how about we talk about the real issue at hand — bullying and the violence that happens in peer groups and at schools. If there’s a conversation we should be having, bullying is it. School violence and peer group violence are the neighbours next door we’ve been ignoring and seeing as normal for far too long.

It’s the viewer’s job to know the limits of what they can emotionally digest when watching shows like this, and have informed conversations about suicide and its prevention. Better yet, let’s delve beneath the controversy of one suicide scene to look at thirteen episodes of a TV show that shows bullying and violence many teenagers are subject to every day. Be angry that we’re not talking about suicide enough. But be even more angry with all the reasons people end up killing themselves.

My only sibling killed himself. So I know what it feels like not to get a reason why.

And yet I knew why — there were many reasons why, some of which were people. I saw a video on Facebook that I can’t seem to track down again, but I’m sure it’s out there somewhere; it was a woman talking about why she didn’t need to see 13 Reasons Why because her best friend killed herself when they were teenagers. Just because someone you cared for deeply took their own lives doesn’t suddenly make you an expert on suicide and excuse you from learning more about the subject. I mentioned earlier that people without lived experience need to expose themselves to suicide through story and more formal education; this stands for people who do have lived experience as well. My brother killed himself, I tried and failed, but that alone doesn’t mean I know a lot about suicide — I just have lived experience of it. Despite the years I’ve spent studying suicide, I still know there is much more to learn. Having the lived experience perspective enriches research and helps me navigate it more realistically, but I’d never approach someone who is suicidal with assumptions based on my own experiences. That’s not only disrespectful of that individual’s story, but could be damaging in preventing further suicidal ideation and/or intention.

So here’s what you can do to become more comfortable with suicide:

  • Listen to personal accounts of suicide survivors; don’t speak, just listen. This account, for example.
  • Research media portrayals of suicide — were they written by people with lived experience? Are we seeing the full perspective? Be curious in your investigations.
  • Seek out education rather than assume knowledge; suicide prevention starts with an open mind.
  • Say “suicide” out loud to yourself. Say “Are you feeling suicidal?” out loud to yourself. Make it feel like a normal question to ask.
  • Take a local suicide prevention training. QPR, for example, can be done in an hour. The next suicide prevention training I’m doing is two days long, so look at what’s available in your area.
  • However, don’t be formulaic about suicide prevention. Every person’s situation is different, which is why suicide prevention can be difficult.
  • If you are mentally well to do so, watch shows like 13 Reasons Why and think critically about them. Suicide is not a black and white issue. There are reasons why people kill themselves. Many, many reasons.

Like it or not, 13 Reasons Why is what happens when you mix research and lived experience into a visual art form. And many people must have enjoyed it enough because Netflix renewed it for a second season. So I look forward to critiquing the next season and hopefully seeing a different conversation about bullying and suicide surface when it comes out. I welcome informed discussion on this topic and hope that, unlike many discussions I’ve seen online, we can be civil in engaging in an intellectual debate. Because, ultimately, this isn’t about which opinion is right or wrong — this is about understanding the nature of society and how it contributes to suicide. This is about opening a conversation to help people through evidence-based resources.

If you or anyone you know is feeling actively suicidal right now, here are some ways to get support:

Click here for an international list of crisis lines.

Suicide Prevention help in Canada.

Download a pamphlet on quick tips about suicide prevention.

More resources on my website for Canadian and American residents.

You’re not alone.

What does it feel like to have bipolar disorder?

Every time someone asks me this question, I ask them this question: “Well, how much time d’you got?”

It’s a good question. I’m glad people are asking it. But it’s not the best question to ask from my bipolar perspective. It’s kind of like if I were to ask someone, “So, what’s it like being you?” Where would you even begin to answer that question? More importantly, if you only had a few minutes, how would you feel about your answer? Would it represent who you are? I like to think we’re more complex than that.

When people ask what bipolar disorder is like, I think what they want to know is what it’s like being manic, being depressed, living with the stigma, taking medication, hospitalization, etc. — the details. But I think it’s easier to ask the broad question rather than the specifics — perhaps due to fear of prying and other factors, I’m sure. Yet asking “what’s it like having bipolar?” is a very personal question. Sometimes it’s a question that is very raw and emotional for the person now faced with answering it. Sometimes it’s a question people are still struggling to identify in themselves. There’s no simple answer and the answer is different for everyone. It’s no different than asking what it’s like existing on this earth; it’s just a certain kind of experience that not everyone has.

There are plenty of experiences I don’t have that I’m curious about. I’ve probably made this mistake somewhere along the way of trying to understand a broad experience rather than the person in front of me. What dismays me is there are more than a few articles out there on the World Wide Web that start with “this is what it’s like having bipolar disorder”. To my relief, some of them do come with the disclaimer *that this is just what it’s like for me. But many don’t, and therein lies the issue. Every person describing “bipolar disorder” is describing their lives in the context of having bipolar disorder. It’s an important distinction because we’re unintentionally stereotyping bipolar disorder by not pointing out the individuality inherent within that clinical label.

So in an effort to try to nudge people to ask different questions, here are some of my suggestions if you want to approach someone who has already disclosed their bipolar disorder to you:

  1. Ask them: “Hey, how are you? How’s your day going?” Have a genuine check-in with your feelings and theirs. This is how we start conversations when we sit down and acknowledge another human being.
  2. Everyone’s feeling okay? You might say something like this: “So I’m really curious about your experience of bipolar disorder. Can I ask you some personal questions?” Yes, they’re personal questions and it’s good to acknowledge that. If they say no, be respectful of their boundaries.
  3. If they consent to answering your questions, ask away, but be mindful of headspace. Did that person just get out of hospital? Maybe not the best time to be asking them about their experiences.
  4. Be honest with your questions. If you want to know about their most extreme manic episode, then for god’s sake just say so. It’s alright to be curious. Don’t dance around the burning question. You’re by no means guaranteed an answer, but I can definitely say I appreciate it when people get to the point. Also, don’t get upset if you don’t get an answer. It’s personal and confidential information, remember?
  5. Be thankful and express gratitude that this person is willing to share intimate details of their life with you. It takes a lot of trust to tell someone those details.

Even someone like me who writes extensively about my experiences online, I still won’t answer any question that’s posed to me. I choose what kind of content I’m comfortable sharing. There are some questions that only my closest loved ones will ever be privy to. So a rightful ending for this, I do believe, is the emphasis on interpersonal relationship building. You’re not getting to know someone with bipolar — you’re getting to know someone. Just think about that.

Medication and Self-Stigma: Swallowing Pills or Pride?

Taking medication for a mental health condition isn’t exactly something people tend to broadcast to the world, nor prance around in a field blissfully thanking the gods above (or below, depending on your religious beliefs). In fact, society somehow got this notion that taking medication for a mental health symptom is like locking oneself in a closet; you’ve either been shoved into it by force or you’ve accepted being the kind of nonsensical person who does that. There are a few fallacies with this type of thinking that are relevant for minor and more severe mental health symptoms; they tend to coincide with some common myths of the reality of medication.

But first: Why take medication for a mental health symptom?
The answer for this is simple — just cross out “mental” and you’ve got the reality of the situation. What we refer to as “psychological” — aka it’s “all in your head” and you just need to try harder/better/faster/stronger/be not human — is still based in biology. All the thoughts, emotions, and behaviours that we think, feel, and do all have neuronal underpinnings. A great example of this can be seen in Alzheimer’s when — to put it simply — brain matter is compromised enough that a lot of people who have Alzheimer’s end up having personality changes. Yet, we wouldn’t hesitate to give someone with Alzheimer’s medication for these behavioural changes (if we could) because it’s not a mental illness on the same page as bipolar disorder.

The development of the term “mental illness” has set it apart from all other illnesses. That’s not to say that other illnesses are not stigmatized; HIV/AIDS used to be a heavily stigmatized condition, and never escaped that stigmatization completely. People get bullied in school for having type I diabetes (among so many other things kids can think of to bully each other for). I think that’s more reason why mental illness needs to be thought of as either just illness, or as conditions with spectrums of symptoms that may or may not congregate to form a distinct diagnosis. People take medications for mental health symptoms because it’s just another way the body can be sick. Medications, at the physiological level, do different things, but they all share the common goal of improving health.

Yeah, but why take medication for a mental illness when you could just exercise/eat better/get out more/etc.?
These are all things we can do to help our bodies maintain wellness, but imagine someone tells you to just “try harder” to make your flu go away. Again, this is the idea that having a mental illness doesn’t necessitate any biological treatment. And sometimes it doesn’t, just like sometimes all you need is to rest and to drink a lot of liquids when you have a cold. But when you start to have a migraine that makes everything in life unbearable, you probably wouldn’t hesitate to take some medication for it; in fact, many would encourage that you do. Strangely enough, when depression makes everything in life unbearable, we give people different advice. All because we think mental health symptoms like feeling worthless or suicidal ideation are “all in your head.” But even that takes on a different meaning when we realize that we all have this amazingly complex organ in our heads that we call the brain. Just because a lot of people don’t understand how biology and psychology are intertwined doesn’t magically make that concept invalid. Biopsychology, behavioural neuropsychology, “brain and behaviour,” or whatever you want to call it — these are entire fields of study that are often ignored and more often misinterpreted.

Okay, I guess I’ll believe science. But taking medication makes me feel weak.
Yup, been there, done that, continue to be there. I’ve been on and off anxiolytic medications because I thought I could power through my anxiety, or be “strong” enough to deal with it without medication. I’m still learning that taking medication for my mental health issues doesn’t make me a lesser human. That idea is purely cultural, meaning that we’ve collectively decided that medication specifically for mental illness/mental health means a certain thing contrary to other illnesses. We don’t shame people for taking anti-nausea medication, and yet there have been more than a few occasions when I get a treated differently by a pharmacist when I fill my lithium prescription. (Once one started speaking to me slowly and guiding me through side effects as if I had never encountered the idea of medicine before and all I could think was Oh honey, you have no idea who I am.)

Self-stigma is the name of the game. I, like so many others, have internalized the Canadian and American stereotypes of mental illness. The aspect that I want to consider in this piece is the idea of swallowing one’s pride when one swallows a pill. In my struggles with anxiety, I was clinging to this ideal version of myself when I should have (and should be) acknowledging my reality. That reality is that I self-stigmatize when I know I need medication to help me function and maintain wellness, and sometimes I act accordingly by not taking medication when I need to. For me, it’s like not taking a painkiller when I have a headache. Sure, I could suffer through the experience and waste my time with the pain, or I could take the medication and continue with life as I normally do.

Knowing how culture influences these ideas, as well as understanding the science behind them, is a great step in understanding why medication and mental illness is such a debated issue. The sad part about this issue, in my eyes, is how many people could be helped by medication right now but don’t because our dominant culture (speaking as a Western Canadian) says it’s not something we should or need to do. Sure, there are other issues such side effects and the pros and cons of this medication or that. It’s not a simple topic; there are lots of things to consider, such as over medicating symptoms that can be managed through other avenues of treatment. But medication can give someone a baseline to get back on track with life. Don’t we all want our fellow humans to be well and contribute themselves to society? Some food for thought.

I’d like to end by saying I take an objective stance on medication. I’m neither for medication nor against it, though it may certainly seem like I am for it. This moves toward a greater conversation of seeing certain symptoms of mental illness as positive rather than negative experiences. To medicate or not to medication — that is the question.

Stigma is the Worst Part About Having a Mental Illness

As someone who has become functionally stable with the use of medication, lifestyle changes, and lots of social support, I now face the reality where stigma is the biggest challenge in managing my bipolar disorder. Even someone as outspoken as I am about talking about my mental illness and advocating vulnerability as a means of social change, sometimes I still stutter when trying to explain my health problems to friends. Stigma is a multifaceted problem that has many layers, including self-stigma, but for the first time I really want to address social stigma and how much more seriously we need to be talking about this — because it happens in some of the most unlikely of places.

One of those places happened to be in the psychology department where I spent a lot of time as an undergraduate student majoring in psychology. I’ll keep this particular instance vague, because part of me still fears the repercussions of simply speaking out, but it was an event that still pops up in my mind from time to time as in, “Hey, remember how shitty that was?” I had come to a point in my studies where I was requesting academic accommodation in order to ease the symptoms I was experiencing — a lot of anxiety and general chaos in my mind that I was having trouble coping with. So I sent an email with my circumstances, along with a stern request to be taught material my peers were learning but I was not (of which I had recently become aware — for reasons unknown). I offered up a doctor’s note and thought it would be accepted without a problem — instead, I was treated like I was making excuses to get out of doing work. This professor literally told me they believed me to be making excuses, despite my doctor’s note.

From a purely teaching perspective, now that I have credentials to be speaking on the matter, this behaviour on part of a tenured professor is not conducive to a positive learning environment at best; at worst, this kind of behaviour can cause a student to lose hope in their studies, and perhaps contemplate suicide (which I did briefly). As someone who studies educational psychology, this experience was not just a failure in teaching (be it from the professor or how the professor learned to teach, or both, or even other factors), but also a failure in compassion. And that, I believe, is why social stigma hurts so much. Social stigma is the failure to apply empathy.

To these people who have come and gone in my life, who chose stigma over support, I have this to say: I wish you well, and I hope if we meet again we can talk about choosing support over stigma.

I could go on about this experience, but I try not to dwell on it. It hasn’t been the only situation I’ve found myself in where I’ve been accused of using mental illness as a scapegoat. What made that particular instance of social stigma so tragic for me is how little social support I had during that time. The greatest reason on my part, though, is that I was terrified of disclosing the fact that I had bipolar disorder. And the worst part about that is I was blamed for not disclosing it sooner. Suddenly the onus was on me to be completely open with my health despite never being told how I should do that and never feeling safe to do so.

Of course, I’m now completely open with my professors in my graduate program — and everyone else, really. I completely believe that one should disclose one’s mental health condition to the people it might affect later; this benefits me by allowing them to give me the support I need. The difference between now and then is now I have colleagues and “superiors” in my life who do this: They may not understand what mental illness is or what it does, but they choose support over stigma. Instead of jumping to conclusions and judging me for being unsure of how to present my condition to them (because no one ever told me how and sometimes it still feels dangerous), they listen and ask me questions. They try to understand and thank me for being open with them. And they don’t blame me for withholding information because I was scared of their reactions.

If someone tells you they have a mental illness, forget everything you know about that mental illness. Listen to their story and appreciate the leap of faith they take in telling you that information.

Social stigma takes many forms — this is just one story out of many. Although I have found enough courage to face these situations with strength when they arise, there’s still no template for doing it right or avoiding a fight. Both parties can make mistakes, but those mistakes should be made in an atmosphere of support, not stigma. I never expect people to understand bipolar disorder, but I expect them to try. Stigma can very easily become a cause behind relapse. Those of us who struggle with mental health symptoms and those of us who are supporters know this scenario too well.

We could think of stigma as a lack of empathy, and it might be easier to stop stigmatizing behaviours if we think that way. That’s not to say that people who have stigmatizing beliefs about mental illness have no empathy; it’s just saying that those beliefs lack empathy and empathy needs to be cultivated in that particular realm of thought. Stigma from the perspective of someone with a mental illness can be seen as an attack on the existence of an individual. However, I like to believe that most of us mean well at heart and we all have the ability to change stigmatizing thoughts into supportive thoughts. We can modify our behaviours to be supportive rather than stigmatizing. The big question, of course, is how? Well, I’ll be writing about that in due time. For now, I hope I’ve gotten across the beginning of a conversation on this blog about cancelling out stigma and switching to support.

5 Changes Bipolar Disorder Treatment Needs to Adopt

From the stories I’ve heard along the way of recovery, a story people seem to share is how difficult treatment is if you have bipolar. There is a narrative that says treatment is difficult because it’s hard finding the right medication to get your mood episodes under control. While it’s certainly true that medication can be difficult to settle on, for far too long treatment of bipolar disorder has ignored other equally — if not more so — aspects of treatment; these are aspects that can even make medication an easier journey. So here are the ten things I think need to change when treating bipolar disorder:

Bipolar disorder is not a curse that needs to be lifted.
When I entered treatment, the focus was on getting me back to “normal” as soon as possible. Years later, I feel like I missed the opportunity to examine mania and depression in a meaningful context — to see the good and the bad in both, to find the lessons and the knowledge. There’s a lot of emphasis on staying away from the bipolar experience, when — as I’m finding — a lot of people consider it a very important aspect of their personalities. Treatment needs to provide a safe space to explore these issues, rather than shut them down and make the goal to function like a regular human being as quickly as possible (as much as we all want this, of course).

The clinician-client relationship needs to be more of a relationship.
In my studies of education, we talk a lot about the responsibility of the teacher to provide a foundation and relationship for the student. However, we also talk about whether or not the teacher gets loaded with too much responsibility in this way. I have similar feelings when it comes to the clinician and the client relationship, so I acknowledge the complexity of this matter. However, the clinician (usually the psychiatrist) is often the anchor for someone who has bipolar. Feeling alienated from your psychiatrist will make treatment more difficult; I certainly didn’t want to take my meds when I was seeing a cold and unfriendly psychiatrist. Having a psychiatrist now that has a regular conversation with me makes me feel comfortable to share more knowledge with her that can help her treat me better. That being said, someone with bipolar does have to meet their clinician in the middle. It takes two to make a relationship work. It’s also good to remember that there are two experts in the room, especially when only one of those people has letters after their name.

“I don’t know” is not a great way to say there’s not a solid answer.
A lot of people, myself included, have asked their clinicians questions that ended in “I don’t know” with no further follow-up. There’s absolutely nothing wrong with not knowing, but stopping there is a misdeed. Clinicians take the role of teachers whether or not they want that. What I want is “I don’t know, but…” and then a theory, an article, a guess, a “I’ll ask a colleague,” or let that be the beginning of another conversation. I can debate about the circadian rhythm system with my psychiatrist because I have that knowledge, and I appreciate that because it makes me feel like I have a voice and that matters (and it helps my treatment). Some people don’t have the science terminology to grasp those things, but even then I see that as a learning opportunity. Have a client that doesn’t know the first thing about how meds works? Teach them. Give them a pamphlet. Refer them to a website. Do what you have to do. Education is a crucial part of treatment, even if the client is hesitant or disinterested.

It’s time to adopt a holistic model of treatment.
Few things in life occur in isolation. History has seen the treatment of bipolar as mainly biological. We now know that people who have bipolar are people gasp and lifestyle considerations need to be talked about. There are already clinicians doing just that, but it’s still an idea people are getting used to (clinicians and people with bipolar alike). I have a life to manage and my bipolar is an integrated part of that. It affects my relationships, my work/school, and things like sleep hygiene that can affect how well my medication works. Traditional treatment is enhanced when the world beyond the clinician’s office is considered and implemented into that treatment regime.

There’s this thing called positive psychology…
…and it overlaps nicely with everything I’ve just said. For those who don’t know, positive psychology is an area of study dedicated to understanding what allows individuals and communities to thrive. Those who follow my progress in the blogiverse know that I often use the word “thrive” when I talk about bipolar, mainly because of the stigma that says people with bipolar are crazy and useless and what have you. Bipolar disorder is just another medical condition, not a special ailment that puts a permanent blockade between you and success. Thriving needs to be discussed in treatment — not just coping or being fine. Some may argue that thriving is up to the individual when the “back to normal” process is underway. I disagree. I know how to achieve success in my life (and I have), but I need help knowing how to achieve that in a way that doesn’t compromise my wellbeing. Recovery is an ongoing process, one that does include thriving. At this point I feel like this is natural conclusion to this article:

Side effects of thriving may include a profound sense of wellbeing. Talk to your doctor today to see if thriving is right for you.

Creativity & Medication: Buzz kill?

This post is not going to be about the relationship between creativity and bipolar, which I can neither confirm nor deny but suggest more research upon. Instead of trying to pull apart what creativity actually is, I’ll leave it up to you to realize your own definition of your own creativity. No matter what the ends up looking like, there’s lots of people out there who feel dulled in one way or another when they’re taking medication. This isn’t a simple matter, but a simple answer could be that certain combination of meds combined with certain people makes for feeling less creative. That’s just one answer. Having both bipolar and artistic tendencies and knowing a thing or two about brains and stuff, I’ll discuss this further.

There’s a large misconception that starting medication means your creativity shuts down shop and leaves you for a mysterious lover. Obviously that’s not the case, because here you have a medicated person who just conjured a horrible but creative metaphor. Personally I don’t feel like my creativity has ever been affected by my medication. However, what has been affected by my medications has been my mental clarity/fogginess that can affect my motivation to do creative things. In that there is an important difference; feeling creative, doing something creative, and being motivated to act on that creativity are all different things in my book. Some people may feel differently than I do about it, and that’s valid too. Emotions are, after all, uniquely individualized.

From my experience with psychotropics and hearing others’ experiences, it’s hard to pin down any relationships between specific meds and creativity. Taking divalproex sodium, for example, left me feeling — for the lack of a better word — stupid; I was essentially reduced to a zombie. Quetiapine, as another example, let me feeling tired and groggy for most of the day so the choice was usually between more sleep and being productive (guess which won). But other meds have done nothing of that sort, and allow me to channel my creativity from my mind into the coordinated muscle movements I need to do art. However, I’ve talked to people who take divalproex and feel energized by it. Quetiapine usually makes people sleepy, but at certain doses that wears off and creativity, if hindered, continues to bloom. It really depends on the person.

Something else to note briefly is the possibility of underlying medical problems that could be contributing to decreased feelings of creativity. Personally, I’ve struggled with iron deficiency that leaves me feeling tired all the time — too tired to want to pick up a pencil and draw or even write at some points. Once my iron levels get back up to normal, I usually feel back to normal and can continue with my creative pursuits. Like iron deficiency, there are plenty of other problems out there that could be interfering with your creativity so it’s always good to rule out as many variables as possible. That being said, sometimes medications do sap the creativity right out of you. I believe that a good treatment regimen involves prioritizing well being, and if creativity is a huge part of your wellness then that’s a conversation to have with your healthcare professional.

In sum, wellness is an understated priority in treating bipolar. Creativity is part of wellness, and overall health should be examined to make sure there aren’t any underlying factors contributing to decreased creative flow. Some medications do decrease the ability to feel creative, but it’s a case-by-case basis so unfortunately there’s no guide for it. But all things can be remedied with conversations like this one, so hopefully that’s some food for thought for your day.