One of the most awful aspects of having bipolar disorder is dealing with the shame that comes after having manic and depressive episodes. Our symptoms are caused by a chemical imbalance that makes us behave in ways that can be confusing, hurtful, and problematic to those around us. Because our illness causes a change in behaviour it is difficult for people to separate our symptoms from who we are as people. As a result, individuals in our life may change the way they treat us after an episode. This along with memories of the episode can all contribute to a heavy sense of shame.

After manic episodes, people who are impact by the episode may react to the person who had it with anger, resentment, and fear. It is not my place to say which of these feelings are valid or not valid, but I believe the fear is often a result of the media and entertainment industry’s love of portraying people who have mental illnesses as violent. We are no more likely to be violent than the general population. Feelings of anger and resentment are valid but a challenge to process because we would never choose to behave the way that we do when we are acutely ill. Being the brunt of this type of negativity is hard on our self esteem and it diminishes our ability to have a positive sense of self.  

The shame that comes from depressive episodes can be different. These episodes may result in friends breaking off contact from you because you are no longer pleasant to be around. You may lose a job because you are not able to perform your duties or a relationship with a spouse may end as they feel you are no longer capable of being a positive influence in their life. These episodes are not our fault, but the consequences on our lives are considerable and can be hard on our sense of self worth.

It is not just the reaction of people around us that is difficult, but the memories of our behaviour can bother us as well. I remember saying awful things to loved ones during the height of my irritability and the confused faces of people who did not understand my psychosis. These memories used to weigh heavily on me, and they made me wonder if I deserved to pursue a better life.

One of the ways I recovered from the overwhelming shame was by attending a peer support group at OBAD. It was nice to meet people who had bipolar disorder that managed to have a positive life and almost everyone could relate to my experience of dealing with shame. Attending the group and trying to focus on living in the moment rather than ruminating on the past has helped.

I have heard stories of family members repetitively reminding people who have bipolar disorder of their behaviour during acute episodes because they are angry or hurt by what happened. While it is understandable that one would want to seek comfort after being hurt by these events, constantly reminding someone of their behaviour when they were acutely ill is hurtful. It may be more helpful to seek out support from agencies like the Organization for Bipolar Affective Disorder, the Canadian Mental Health Association and the DBSA who have groups and resources for family members of people who have bipolar disorder.

Feelings of shame after acute episodes can be so debilitating that it may hinder the possibility of returning to a functional life. Even if I deserve to be punished for the pain my illness has caused people connected to my life, surely a life sentence of crippling shame would be an excessive punishment. To minimize the negative impact my illness has on those around me, all I can do is make lifestyle choices that are conducive to making my symptoms manageable. I cannot do this if I am stuck in shame.

 Everyone who has bipolar disorder has their own unique version of the illness. We all understand what it is like to be stuck in the physical anguish of a depressive episode and the euphoria of hypomania but the severity of our symptoms, how they manifest and how we respond to medication is different. It is important to learn as much as possible about your bipolar disorder to have a positive life.

For example, after my last manic episode, a psychiatrist told me that taking too much pleasure in creative thinking, solutions to problems or philosophical ideas can trigger a manic episode for me. He called this, “Intellectualizing.” When I reflect on all three of my manic episodes, I realize they were all triggered by intellectualizing. This means, I am careful about what I talk about and think about. I do not push my brain to the edges of philosophical questions, and I am mindful of how excited I get about my own thoughts.

I have learned from my experience of having depressive episodes as well. When I am in my car and I notice that I keep changing the radio station I start to wonder if my mood is dipping. An inability to enjoy things is a symptom of depressive episodes and this can be the first sign that this is occurring for me. Then, I think about whether or not I am having other symptoms like poor appetite, fatigue, and lack of concentration. If I am, I add more physical activity to my routine. This does not make me feel better, but it prevents things from getting worse. I force myself to eat to prevent my appetite from dropping even further and I meet people to reduce the possibility of self isolating.

Medication plays a crucial role in managing bipolar disorder. Without it I could become acutely ill on a regular basis which could potentially be fatal. There is no imaging device or blood test that a psychiatrist can use to assess the symptoms of someone who has bipolar disorder. They rely on their observations and our report on what is happening in our life. To make this process more effective you can use mood charts that rate your mood daily to learn about patterns that may exist. Also, Crest.bd has a Quality of Life Tool that asks you a series of questions and produces a report that can help you understand how you are doing in the context of your illness.  Providing this information to your psychiatrist can improve your treatment.

When you have bipolar disorder, creating a routine that includes consistent opportunities for joy and fulfillment requires learning as much as possible about your illness. Over time, this knowledge can empower you to lead your best life. While it is not a guarantee that your symptoms will never become acute it gives us the best chance to lead a rewarding life long-term.  

A couple of months ago, I had little energy, my thoughts were negative, and I felt sad. I thought it might be the start of a depressive episode, but my psychiatrist told me I was suffering from “Covid Fatigue.” She explained the cumulative effect of the isolation and reduced interaction with people has led to people feeling down but she assured me I was not suffering from the physical symptoms of a bipolar depressive episode.

Had it been a bipolar depressive episode, I would have exercised a little more and made sure I kept eating to combat the poor appetite I experience. Implementing these two strategies prevents my depressive episodes from getting worse and they do not last as long. Although “Covid Fatigue” could lead to poor life choices that could trigger a depressive episode it is a psychological problem which requires a different type of intervention.

The main issue for me has been the impact Covid-I9 has had on my routine. I volunteer at the Kerby Centre, a centre that supports seniors. I find helping seniors rewarding and working with the positive staff fills my emotional need for positive interactions with people. The Kerby Centre is still providing important support to seniors via the phone, online and food delivery but the building is closed which means I am not needed at the moment.

My psychiatrist said we needed to add some activities to my life to help me stay psychologically healthy during the pandemic. After doing some brainstorming we decided that crochet and baking bread would be the answer. It is no coincident that these are two of her favourite activities. I am glad she is not into skeet shooting and gymnastics because I do not think those activities would be a fit for me.  

Learning to crochet was frustrating at first but, now I find it relaxing and rewarding. I have made gifts for people which makes me feel good and it is helping me stay positive because my thoughts are occupied by making stitches. When I start to have negative thoughts, I make mistakes which take awhile to fix. Crochet is helping me train myself to focus on the present moment.

In the last few weeks, I have been attempting to make bread and it has been a challenge. My first attempt was edible but very dense. When I added all the flour that the recipe called for the dough became dry and the bread came out crumbly. I talked to a friend who bakes and she told me she just adds flour until the dough ” feels right.” I had no idea how to make dough that “feels right” but after watching a YouTube video I managed to make a loaf of bread I enjoyed eating.

The brain power I used to figure out how to bake bread was a nice break from thinking about life during Covid-l9 and I am still doing crochet. I am grateful that this trying time has given me these two new skills that I will be able to use for the rest of my life. If you would like to add bread making to your repertoire of life skills, I have included the instructions and recipe that I used below.

The other day, I went for a walk with a friend. We climbed to the top of a hill where we could see the blue sky surrounding the downtown core and the mountains in the distance. I felt gratitude for the cool fresh air in my lungs and the beautiful expanse. You would think I would do this on my own all the time because it makes me feel good, but I don’t.

I have a confession to make. I really enjoy activities that are sedentary. I like to write, play solitaire, watch Netflix and sports. I am not one of those people who wake up early to jog or swim laps. I am more of a wake up late and remain in a cognitive fog until the afternoon kind of guy. I regularly go for walks with friends but rarely on my own. As a result, I can end up staying home wasting time on less meaningful activities which results in me feeling guilty and lethargic.

One of my challenges is I, like many people who have bipolar disorder, have ADHD (Attention Deficit Hyperactive Disorder). People with ADHD have a problem with something called, “Task Initiation.” We struggle when a task requires the completion of multiple steps. A person without ADHD could decide to go for a walk and just leave. If you have ADHD, your thoughts will be like this: “What to wear? Where to go? Runners? Weather? Clothes? Should I leave now? Music? No Music? What time is it? Do I have time? Weather? Do I have time? Clothes? Runners? Jacket? Imagine having all these thoughts without any meaningful division or sequence. It is overwhelming and discouraging.

The other issue is my bipolar disorder makes me feel tired. My medication is sedating, and my version of the illness lowers my energy level. My body is constantly telling me it just wants to rest, and I battle with the urge to remain on the couch all day every day.

To combat these issues, I have decided to try a new strategy to help me go on walks on my own. I have prepared a comprehensive list of every minute step required to leave to go for a walk on my own and I have scheduled it on my calendar. I have downloaded a playlist on my phone that will make my walk on my own more enjoyable. I hope all of this will inspire me to create a positive loop where exercise improves my ADHD symptoms making Task Initiation less of a challenge.

I would describe myself as an extroverted introvert. I need my alone time and I need my not alone time. Most of the laughter and energetic spark in my life comes from interactions with people. Due to the isolation in my life because of Covid-19, I have not been able to do my volunteer job, play badminton, and go to coffee shops which has been hard on me.

Several weeks ago, I told my psychiatrist I felt terrible and I thought I might be having a depressive episode. After doing her assessment, she said that it was not a depressive episode, but stress caused by the isolation. The best solution we could come up with was teaching myself to crochet to promote a more positive state of mind and distract myself.

The first thing I tried to make was a hat. I spent more time untangling the yarn and unravelling all the stiches because of mistakes I made than making the hat. I felt like breaking my little wooden crochet hook in half and throwing it off my balcony. Then, I made mittens. I think the designers of the pattern live close to the equator because it had so many big holes that they offered little protection from the cold we experience in Canada.

Then, I received a request from a friend for a crocheted infinity scarf. I looked it up on YouTube and it looked like a scarf that is in a ring. I followed the instructions on the video, and when I was done my ring, it had a twist in it. I thought that was the reason it was called an infinity scarf. I found out infinity scarves do not have twists, so I undid the whole thing and remade it. When I saw my psychiatrist, she told me an infinite scarf with a twist is a mobius scarf. I wish I had known that before I took it apart.

I have continued to crochet despite the stress it causes me at times. Recently, I was making a scarf and I realized that it has a value beyond mindfulness and the satisfaction of creating something new. When I make something for someone, the care I put into making it is an extension of my feelings for them. This experience makes me feel connected to the people I love and reminds me that we are all still together even though our opportunities to occupy the same physical space have become limited.

This blog was published by the International Bipolar Foundation a couple of years ago. The meetings that I describe in this blog have gone online now because of Covid-19 but they have been just as powerful as they were when we met in person.

By: Allan G. Cooper

“Psychiatrists can tell you about the ocean by reading about it and seeing it in their practice but we know what it’s like to be in the water”.

This is how my co-worker Ray explains peer support. We work for an agency called OBAD, the Organization for Bipolar Affective Disorder, in Calgary, Canada. We facilitate drop in peer support groups for people with the illness.

When I went to my first meeting, I was experiencing another crippling depressive episode. My connection to life seemed to be fading away and I was on the verge of losing my job. I only had enough energy to barely feed myself and lie in bed obsessing about suicide.

I called the distress centre line in Calgary and they put me through to the Mental Health Mobile Response Team. They came to my home to meet me and they suggested I go to an OBAD meeting.

I could barely find the energy to walk and forming a sentence in a social setting seemed impossible. I hated support groups. I felt like they just confirmed the fact that I was different from everyone else. But, I had become hopeless and I was desperate to find anything to make the pain stop.

At my first meeting, I sat with my head down avoiding eye contact with everyone. Partially because I can be shy around new people but mostly because I was just exhausted.

When the meeting started I was surprised that the facilitators also had bipolar. As we went around the room, people talked about whatever they felt like including suicide, psychosis or sometimes they just talked about their day.

When it was my turn, I was nervous at first but one of the facilitators gently coaxed me into sharing with the group. Reluctantly, I began to talk about my life and that is when I first experienced the magic of peer support.

I told them about my suicidal thoughts and my shame for having them along with the perception that I was a coward because I couldn’t do it. I told them that I was afraid of losing my job, my friends and financial stability. Everyone nodded in understanding as I spoke.

When people said words of encouragement to me they started with, “when I was going through …”. Everyone, including the facilitators, talked from the perspective of their own personal experiences. It was like opening a can of instant hope.

Sometimes, when people who don’t have bipolar ask me about our meetings they find it confusing.

“So, do you guys have topics?”

“Nope.”

“Do you have coffee and snacks?”

“Nope”.

“Do you have a list of rules on the board and write down goals?”

“Nope”.

“I don’t get it. What’s the point?”

The fact that they don’t get it is precisely the point. When you attend an OBAD meeting you can relax and take off the costume of pretending to be perfectly fine. You can be in a severe depressive episode and not be able to say a word and the group will genuinely congratulate you for making it to the meeting.

If you are hypomanic and babble on and on, the group may help you by dropping hints or sharing stories of the damage that hypomania can do to your life. Or, we just listen and when you come down from the high there is no reason to be ashamed or embarrassed because we all understand.

After I started to attend meetings regularly my life started to turn in a positive direction. I did not lose my job and I was able to achieve a lengthy period of stability after that first meeting.

The shame I had of having the illness dissipated and the tips I learned from the facilitators and other members of the group proved to be invaluable.

Seven years ago, I became one of the facilitators of the group. I have had the privilege of seeing the progress of people’s recovery first hand. The day someone is able to smile after an extended period of suffering is special to me. They are usually not aware of the change because the transition is so gradual but it is a distinct moment for me.

If you have bipolar disorder even though it may feel like it at times you are not alone. You share a special connection to some of the most extraordinary people in the world. We are in this together and with the help of our peers we can stay well and find joy in our lives despite the suffering.

Imagine walking down the road and as you stroll past one block you have a career, a spouse, money, and friends and then by the end of the second block you have none of these things. In their place, you receive the ire of people who are angry, afraid, or frustrated with you. This example is similar to what some people with bipolar disorder may experience within a couple of months.

A severe depressive episode can leave you unable to perform your duties at work causing loss of employment, resulting in financial problems that lead to trouble in your marriage ultimately ending your relationship.  A manic episode might cause you to overspend, have an affair, or your colleagues and friends may become fearful of you because of your psychosis. This can all lead to a loss of relationships with friends, colleagues, family members and spouses and all your life savings.

After my last manic episode, I had this level of loss. It had been the third time it had happened to me. I felt done with life. It seemed like no matter how hard I tried bipolar disorder would never allow me to be happy. I had lost my job, moved to a small town where I did not know anyone, spent all my money and alienated myself from my friends. The depressive episode that followed was so debilitating I rarely got out of bed and my appetite was so poor that I only ate one sausage roll and a glass of orange juice on the good days. Some days, I did not eat at all.

To rebuild my life I received a lot of support from my family. They ensured I had my basic needs met and called me regularly to offer support and encouragement. In addition, I started going to a peer support group that I used to attend regularly at an organization called OBAD. I felt embarrassed that I was manic and extremely obnoxious at the last meeting I went to but when I saw my peers again it was a relief. People were happy to see me and my peers perception of Allan had not been tainted by the symptoms of bipolar disorder.

With the support of the group I was able to gain the emotional resiliency and confidence to move back to Calgary. It was nice to be back in my hometown. I reconnected with friends and being in the city offered me more opportunities to build a healthy routine.

My psychiatrist recommended I look for a volunteer job. When I was a child my grandmother used to bring me to a centre for seniors to have lunch and play badminton called the Kerby Centre. I decided to volunteer there in the Information Department and Volunteer Department. The positions provide structure to my week, a sense of fulfillment and interacting with the appreciative staff creates a positive energy that contributes to my wellness.

I became a facilitator for the meeting at OBAD in 2012. It is amazing to be involved in the recovery of so many extraordinary people and I still learn things from the meetings that I can apply to my own life. It has been my experience that people with bipolar disorder are compassionate, creative and they have an insightful perspective on life. I am grateful for the honor and privilege of working with my peers.

Rebuilding your life after the devastation of an acute episode can seem impossible. Peer support can help because you meet people who have done it which can give you hope. It is an awful and lengthy process that requires self compassion, determination and supports from the ones we love. In the end, it leaves us grateful for a life of stability that includes moments of joy.