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What Does Mental Health ‘Recovery’ Actually Mean?

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Recovery. It’s a word used a lot in the mental health world. Ask anyone — psychiatrists, psychologists, counselors, family and consumers — sustained recovery from an episode of mental illness is what we all strive for.

However, what does “recovery” look like? No person’s recovery is going to be the same; therefore, no recovery goal is going to be the same. I have bipolar disorder, and unfortunately, I am in the group of people who don’t respond that well to medication. Medication can stop the great peaks of manic elation and decrease the time spent in the most despairing depths of depression, but for me, it is not a miracle cure, and I still get residual symptoms.

In an ideal world, everyone would love for my recovery to mean the cessation of all manic and depressive symptoms — for me to be constantly euthymic (stable) — but we don’t live in an ideal world. For that to happen, I would have to be on a lot more medication with higher doses. I’ve been down that road before, and for me, the side effects don’t allow for much quality of life.

Instead, my recovery goal isn’t to banish the symptoms completely, but to live with the ones medication can’t get rid of. In all honesty, if I did have the option to banish all of my symptoms, I’m not sure I would take it. I’ve lived for so long with ups and downs that I’m used to that way of life. For a long time, what I thought was my “normal” self was actually my hypomanic self. It’s confronting when the person you thought you were turns out to be an unwell version of you.

New approaches to recovery in mental health are person-centered, which is about what the individual person wants for their recovery. Previously it was thought that if someone with mental illness was completely symptom-free, they were in recovery. Now it is recognized that this isn’t necessarily the case. As I said previously, if I were to live a life free of symptoms, I would have to be over-medicated, miss out on the social life of a 25-year old and have a decreased capacity to work and study.

I bet I’m not alone in this scenario. What’s the point of being symptom-free if you have no quality of life? Is it any wonder some people aren’t always concordant with treatment?

Instead, a happy medium has to be reached so we can live to our full potential. For this to happen, there has to be a dialogue between you and your treating professionals as well as the loved ones involved in your care. Let your health professionals know what you want for your recovery and explain this to your loved ones so they know what to accept as part of your recovery. Having everyone on the same page can increase compliance, support and ultimately happiness.

I recently had that conversation with my family. What I want from my treatment is little peaks and troughs. Since the age of 14, I have lived with cycles of depression, so “mild” depression for me is manageable. When I am hypomanic, I function better than normal. Before I was diagnosed, I would instinctively fit my life around my mood cycles — accomplishing as much as I could when I had high energy levels to compensate and prepare for the times of low energy. This is who I am. I am a person who is all-or-nothing. I am someone who lives life fast-paced and with passion, but I am also someone who experiences great apathy or melancholy. I am not a person who sits constantly at baseline. I don’t want to get off my “roller coaster” completely, I just want to switch to a less extreme and more controllable one so I can still enjoy life and feel like myself.

Obviously this scares my family. They’re scared of the elevation turning into full-blown mania where I lose insight and become psychotic. They’re scared of the severe depressions that last for months and that can potentially kill me. However, they also want the best for me and for me to be happy. After a lengthy discussion and re-evaluating the early warning signs that indicate things are getting out of hand, we agreed on what I want from my recovery.

Having clear expectations of what you want from your recovery and letting everyone know these expectations means you can all work towards your goal together. I think the most important thing about recovery is recovering your quality of life. It’s your recovery, and as long as you are happy, functioning and safe, that’s all that matters.

Editor’s note: This is based on one person’s experiences and should not be taken as medical advice. Consult a doctor or medical professional for any questions or concerns you have.

Image via Thinkstock Images

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My Strategy for Riding the Waves of Bipolar Disorder

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At the beach as a kid, I practiced bodysurfing. One of my uncles taught me the basics: watch, wait and hurl. I probably never got it quite right, but I had fun trying. If I picked just the right moment to launch myself into the forward motion of a breaking wave, I could ride the momentum all the way to the shore.

After a while, though, all that pounding water would inevitably wear me out. Sometimes the waves slammed me straight into the sand, and I would emerge scraped and bloodied. Sometimes the salt water poured into my mouth, my lungs, and my belly. Sometimes I forgot to watch my back and a wave would catch me unaware, catapulting me into violent, unexpected somersaults. All of this probably contributed to my adult preference for lakes.

In that battered, exhausted state, when my youthful stubbornness prevented me from simply getting out of the water, I developed another strategy. Rather than leaping again into the oncoming waves, or uselessly attempting to resist their onslaught, I learned to duck.

Going under takes you to an alien world. It sounds, feels, and looks different under there. But it turns out (or at least, it seemed to me, unscientifically, at the time) that the force of a wave plays out mainly on the surface. A few feet down, your hair will swirl, but your body will not be slammed. I wrapped my arms around my knees and allowed myself to spin aimlessly underwater. For a few seconds, I felt hidden, safe from the insistent tossing just above my head.

Life feels a little bit like trying to hang out several yards from shore on a day when the surf’s up. Sometimes you ride the waves with exhilarated abandon, everything that comes your way moving you purposefully forward. Sometimes, you look out wearily toward the horizon and see nothing but cruel, chaotic body-slammers that promise to shatter you.

My recent diagnosis of bipolar disorder makes me feel like I’m bobbing in a choppy sea. Bipolar messes with your mind, changes your sense of self, and makes people look at you funny. It makes you say and do things you don’t want to say and do. It can go away for a while, but experts assure that it never goes away for good, and it may only get worse. The side effects of the medications you must consume can be as horrifying as the disease itself. Sometimes when I contemplate a lifetime with this illness, it terrifies me. It feels like I’m facing an endless series of tsunami-force waves that will pound and pound and pound, until there’s nothing left of me.

And so, I’ve returned in my mind to that childhood strategy of going under. I don’t want to just ride the bipolar wave. I can’t resist it, either. But I can duck. Going under has become for me a metaphor for that old-fashioned concept of submission. It means choosing an attitude of trust and surrender. It means saying, OK I see what you’ve got coming for me. I don’t like it, I can’t change it, and I will trust you anyway. I will duck under the waves and hide myself in the certainty that nothing can toss me from the ocean of your love.

“Deep calls to deep in the roar of your waterfalls; all your waves and breakers have swept over me.” – Psalm 42:7

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How Bipolar Disorder Affects My Professional Life

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Every night before bed, I take my Xanax just as prescribed and slip into a dreamless, black void. I wake in the same position I fell asleep in, groggy and feeling like I only took a small nap. Nine hours of sleep should be enough, but it never is. On more than one occasion I have turned off my alarm and then fallen back asleep because I don’t have enough energy to keep my eyes open. I can’t even count the number of times I have been late for work because I just could not wake up.

Mornings are always the same for me. I have to take a quick shower and if I’m lucky, I have time to blow dry and straighten my hair. On very rare occasions I have time to dress myself up in makeup and jewelry; all the things I buy myself to feel and look normal. My coworkers notice it, too. I know it has to bother them that I’m late nearly every day, and they always notice when I actually had time to get ready that morning. I always feel great about myself when I get compliments about my hair or makeup or even just that I “look nice today.” I like to feel accepted.

I work with people all day long, helping them on public computers, sending faxes, making copies, scanning, etc. I can only work around 25 hours a week because the more hours I work, the more I retreat inside of myself because my anxiety becomes uncontrollable. On a good day, I can make it through work without taking a Xanax, which is usually when I’m between my hypomania and depression. The bad days, though, which greatly outnumber the good, I am forced by intrusive thoughts, debilitating panic attacks, and nonsensical rage to go home early or just not go to work at all. I know I am lucky that I have not been fired the past three years I have been employed at my job, and I am grateful that I was hired at such a wonderful establishment.

On the days I don’t work, I end up doing one of three different things:

1. The depressive days — I sleep all day, finally waking up sometime after 5 p.m., probably getting around 15 hours of sleep. I may take a shower when I get up, but I generally stay in my PJs all day and watch TV with my fur-babies, only getting up to let them out.

2. The hypomanic days — I’m up already before I’ve even slept, or if I try really hard, I might get an hour or two of sleep. Sometimes I lie in bed and just scroll through my newsfeed trying to quiet my mind. After I make myself get up, I have to keep going, so I usually find a new way to move around all of my furniture and rearrange it all by myself. These days I find I have energy to play with my dogs and I often find myself trying to do new things, like finally take them to a dog park, or spend money I don’t have on dog toys. I get myself into too much by making commitments that I can’t keep when I’m not hypomanic, or appointments I know I’ll miss if they’re the next week when the depression sets in. By the end of these days, I can be exhausted, but sleep can be
difficult for a few days until I finally tire out

3. In between — I don’t get as much done these days as I do when I am hypomanic, but I do feel good and I can think, and that’s how I prefer to feel. When I am between episodes, I can settle myself into a book and read for hours. I have so much focus, I feel like I did before my symptoms of bipolar disorder became prevalent. I don’t argue with anyone, and I can do anything that requires concentration or a time commitment. I feel great these days.

After almost a whole year of being diagnosed with bipolar disorder II, I am starting to pick up on my triggers and understand why I am feeling the way I do and what can help me feel better and keep me out of trouble. Sometimes I just want to give up and quit my job because of the guilt of making my coworkers wait on me to get on with their days. Sometimes I feel on top of the world, like I’m an unstoppable force. And then there are the days where I feel like me, and I couldn’t be happier. This is what I live with, and it’s a struggle every day.

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What You Should Know Before You Judge Me for Being Unemployed With a Mental Illness

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“What do you do?”

This is one of the first questions you’re asked whenever you meet someone new. For me, it is one of the questions I dread. We seem to be so focused on what job we hold, as if we are defined by it and like it is who we are. People also tend to judge others who aren’t working, as if we are all the same. People who aren’t working are judged as being lazy.

When I say I don’t work anymore, I see the looks of horror and disdain in people’s eyes. I wait for the interrogation that always follows. I think I need to explain myself to anyone who asks. The worst thing about it is I desperately want to be able to work, but you see, I’m can’t. Here’s why:

1. My illness is unpredictable.

Some days, I can function reasonably well. Other days, not so much and some days, not at all.

2. I am unable to maintain stability for long enough to work.

I have rapid-cycling bipolar disorder. I am lucky to get three months stability between episodes.

3. Stress and tiredness make my illness worse.

I might be able to work two or three shifts. However, this would impact my health and I would spend days or even weeks recovering.

4. I am unreliable due to my illness.

I cannot maintain consistency as my moods fluctuate so much.

5. I have anxiety and panic attacks.

Some days, I can’t even leave my house because of this. I’m worse in public, especially if I don’t have someone with me.

6. I often need to be somewhere familiar and with someone I trust.

I need this to manage my anxiety and to help keep myself safe.

7. I have problems eating.

If I’m not at home to eat, I need to be with someone who I trust. Otherwise, I panic and am often unable to eat at all.

8. My medication has bad side effects, including a tremor and extreme tiredness.

I have to sleep a lot more than normal, including during the day to function. My medication and my illness often prevent me from driving too, which is very restrictive.

9. I must keep regular appointments with my mental health professionals.

This helps to help to maintain my mental health and/or to prevent further deterioration if I am unwell. This is vital. A missed appointment can at worst lead to a hospital admission.

Which brings me on to one of the main reasons I can’t hold a job down:

10. I have to sometimes be admitted to hospital and crisis units.

These inpatient admissions have been and are sometimes necessary when I become unwell either with mania, depression or eating issues (whether I like it or not and sometimes whether I cooperate or not.) I have about three admissions a year on average, each lasting anywhere between three days and six weeks.

So despite very much wanting to work, I hope I have been able to explain some of the reasons why I can’t. Oh and before anyone judges me for not trying, can I just mention I have tried being in employment many, many times. I have worked on and off since the age of 16 in various jobs including shop work, bar work, support work, dancing, cashiering, waitressing, modeling, reception work, teaching fitness, assisting teachers, assisting other people with health problems, working as a first responder and administration. You name it, I’ve probably done it.

I also managed to do half of my nursing training before having to drop out due to my illness. I have two degrees, one in psychology and one in social work amongst numerous other qualifications. Clearly, I’m not totally unqualified and obviously, I’m always trying. I do what I can when I can. I’m also a mum, which obviously comes first and foremost. Although, I wish I could work to provide more for my children. But maintaining anything? Or getting an employer to take a chance on me in the first place? That’s pretty tough.

So next time please, don’t be so quick to judge someone who isn’t working. There may be many good reasons. It certainly doesn’t mean they don’t want to.

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What Mornings Are Like With Bipolar Disorder

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There are days the alarm sounds and I rise. There are other days when my alarm sounds and my heart starts racing. And still there are other days when my alarm sounds and I cannot move. It’s not the weight of the blankets. It’s the weight of my existence. The buzzing continues and in my mind I beg it to stop. Rolling over hurts. On these days it could go a number of ways.

The delusion that my office couldn’t possibly go a day without me. The projects I’m working on that are going to fall apart. This somehow lifts me out of bed. I text my boss letting her know I’m late. Tears in the shower. Tears as I stare in the mirror blowing my hair dry. I can’t figure out what to make for breakfast or lunch, so just plan to go without. On the drive, I promise myself I’m going to keep it together. Fighting back more tears I will them not to fall. I walk into my office as if all is well and turn on my computer. The flood of emails brings on such overwhelm I find myself running to the restroom. Anxiety now fills my body.  I shouldn’t be here. There is no graceful exit at this point.

Another way is to notify my boss I will be out sick for the day and roll over one last time. Sleep well past noon, at least hope to. When I wake again I am full of guilt. I should be at work. I should be a functioning member of society. The tears fall staining my pajamas. Why can’t I keep it together?  I was OK yesterday. Just yesterday I completed reports, answered emails, went for a hike, made dinner. I can’t do this any more. Enter suicidal ideation. I think about all the medication bottles. I think about the bridge only 25 minutes away. The voices begin to shout… you don’t belong here. They are better off without you. There is no more sleeping. Escaping the chaos in my mind. 

When my feet hit the floor I feel weak, flush, scared, uncertain. I stumble around my house for a while not knowing what to do. Eventually I’m a crying mess somewhere on the floor.

The last option is to acknowledge it’s going to be a rough day. I can feel it in my bones once that alarm sounds. I make no rash decisions on whether to go into the office or not. I lay still a few minutes longer and breathe. I need coffee. I do not beat myself up for having bipolar disorder and the subsequent mood fluctuations. I sip my cup of coffee and consider how the day can play out.  I try to stay ahead of the emotional game. I take it one minute at a time.

That third plan is the ideal. It’s a work in progress, or rather what I’m striving for. Mostly it’s a mix of option one and two. I usually get myself to work and I usually have to go home early. I struggle with just allowing myself to be… good day or bad day. But, I’m working on it.

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255. You can reach the Crisis Text Line by texting “START” to 741-741.

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What You Should Know About Living With a Mental Illness That's Here to Stay

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It’s OK, I thought. I’ve been here before.

It was while recovering from my second major episode of psychosis with mania that I realized I would be managing this illness for the rest of my life. The feelings that had accompanied the episode had been familiar this time. Looking in the mirror and not recognizing myself, the bizarre thoughts coming fast and wild, the keyed up, unboundless energy, the fear of sleep.

I approached my recovery with confidence. It had been five years since my last episode and I knew what worked for me last time would work again. I refused to be beaten by this illness.

Accepting that my condition is lifelong is difficult at times. Sometimes, I think other people in my life forget it is something I am facing every day. Yes, I am doing well. I am coping, today.

Here are a five things I wish other people understood that come along with living with bipolar every day, for the rest of my life:

1. I am always thinking about my illness because I have to.

Staying well takes commitment. I have to look after my health daily to stay well, and staying well for me is vital. If I’m not well, then I’m unwell. I have to get a good sleep, eat well, exercise, get fresh air, spend time for relaxation, meditate, engage with others, attend medical appointments and take my medication. I am scared to let any of these pillars of health slip because for me the risk is too great.

2. Taking medication sucks.

Keeping track of doses, prescriptions, side effects, blood level checks and not forgetting to take it is more than inconvenient. It hurts to think I’m dependent on those pills. I wish I didn’t have to put drugs in my body, and I can’t help but resent that it’s something I’ll probably have to do the rest of my life. However, it’s necessary, and for me it works. So I try not to complain.

3. I worry about what people think.

I am lucky I am surrounded by amazing people who understand and support me including my family, friends and colleagues. However, I worry about whether or not to disclose my illness to people who don’t know, as I am never really sure if they will understand. I wish I could be more open with people in my life.

4. It can be tiring.

If I say I need a day off, then I really mean it. Some days I just need to check out and recharge. Please, don’t think I’m lazy or making excuses.

5. I will never “get better.”

I have accepted this is part of my life. I need you to as well. Please, don’t put pressure on me to “get better” or think because I am well today that my illness has gone away. It is always going to be there for me. It is manageable. I am OK with it, but this is something I live with. I need you to be OK with it too and not wish I was different.

Image via Thnikstock.

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