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How to Manage Grief and Bipolar Disorder

In 2015, I was living with my soulmate, in a happy, somewhat insular life with our beautiful 6-year-old daughter. I was working 16 hours as a speech & language therapist. After a somewhat yo-yo pattern of sickness, I had achieved some stability and was in work regularly and working hard.

In 2015, after prolonged pains in his bones and back, my husband received a cancer diagnosis with months to live. Within 10 weeks he had a basilar artery stroke as a treatment complication and went into a coma. After a week we were told he would never wake up and life support was withdrawn. I became a widow.

My initial response was typical  survival instincts, organizing, getting things done and attending to my daughter. Shortly after this the grief came. I attended counseling for 12 sessions and felt things were resolved. Then I almost felt cured and left with a sense of elation and gratitude. I carried this gratitude for the next couple of years, rarely revisiting grief. Making trips round the world, including Barbados, New York and Florida. Paul would have wanted us to be doing this, I would say. For everyone I met I had a gratitude speech ready about my life with Paul. I started taking my daughter to festivals and gigs. Let’s live for today, let’s enjoy now. We barely had a moment to breathe, I was always booking something. I never felt any bitterness or anger, only thanks for what we had.

But there was also the reality of my illness. These euphoric jaunts were punctuated with frequent debilitating depressions. I’ve never had obvious triggers, so initially I just accepted them as part of my rapid cycling. Finally I had to see that the frequency had increased and despite optimum medication intervention, they were continuing to arise. Grief was a trigger; grief was triggering episodes. But what grief? Where was it?

This was answered when my husband’s mum died. I had an excessive response and dissolved into a state of grief that held on after the funeral and beyond. It was classic delayed grief. I returned to grief counseling. It was a gift that the counselor was a trained psychologist with good knowledge on bipolar disorder as well as an excellent grief therapist. I saw him for four months. While I was doing this my theory on grief and bipolar disorder emerged.

I believe bipolar disorder itself delays grief. Due to the emotional extremes we experience, there is little space for grieving to take place. This would be especially true for someone who rapid cycles or experiences repeated episodes across the year.

There is a distinct difference between grief and depression. When we are in a state of depression, we are out of touch with grief. It is not accessible due to numbness and disconnection from feelings. When our mood is elevated we are so concerned with euphoric, happy, creative or goal-driven distractions, it is also nearly impossible to access grief. We may only see glimpses of grief in either of these states, and then it disappears. Or more likely we may not notice the presence of grief at all, but it is likely that it is there.

Then in the periods of remission, when I am usually full of gratitude to be back to health, recovering and catching up, there is not room for grief there either. So when do people with bipolar disorder process their grief? Particularly those who have rapid cycling?

We need to find a way to override the mood symptoms so we can grieve properly. Find simple techniques to observe and process the grief despite the mood symptoms, so we can move on and avoid being stuck in a never-ending cycle of hidden grief-triggered episodes. In my case, I have done that while writing my book. It is an ongoing process, but now I have the simple strategy underway I believe I can reduce the number of grief-triggered episodes. As I am working through my grief, it is not sitting under the illness anymore. I have brought it into the light.

The bare-bones of the strategy is simply coming to awareness. Not just intellectually, but on a practical, psychological and physiological level. Grief needs space. You need to train yourself, despite manic symptoms or depressive symptoms, to notice where grief is trying to break through.

For example, that sense of unease in your stomach like something is wrong. I find I experience anxiety. If I stop and employ certain strategies like sitting, checking in with myself and trying to identify the source, if it is grief related I may start crying and become aware of my thoughts around my loss. Whereas the typical response I might normally have is to keep moving.

When feeling depressed just forcing a five minute check in as many of the days in a week as I can manage, writing at the top of the page “How am I,” can have a profound effect at connecting me with my feelings. The other thing with depression is the tendency to curl up, roll over and ignore any discomfort of feeling. Just focusing on it for five minutes can help to connect with reality and see if there is a grief component. The manic response is to be constantly moving onto something, something that needs doing and something more interesting. But again it is possible to ground and find your grief by making some space.

Some simple things to try:

Activity 1: When anxious/depressed/manic/just because! Making a focused time. Sit and do nothing, but be present. Stay exactly where you are for five minutes and see what comes. It’s very simple. It’s all about making space. I would bet it will be tears. We have a lot of unspent tears and need to allow them to come out in the spaces we make for them, in order to override the effects of bipolar on grief and allow that grief to be released.

Activity 2: For daily practice, five minutes journal time for a “How am I?” check in with yourself. It can be as little or as much as you want to write. But make that check in.

These are not rocket science. But actually when you are experiencing bipolar illness do you need rocket science? These simple strategies work for me and have facilitated my grief process enormously. These are the main two strategies I am using. When you are in an episode of illness you might not be able to do a whole mindfulness activity, but you can just sit and notice for five minutes. You might not be able to do journaling but you can answer the question “How am I?” These are all the things I have needed to do. Cultivate some discipline around these simple things.

You might be surprised at what it triggers. Be prepared that sometimes it may be an intense emotional experience. But at the end of it, you will feel better and will have found some of your sorrow and processed it. Look after yourself; wrap up in a blanket. Sleep. Write if that’s something you enjoy. Sometimes a sugary tea will be enough. When I first started with these techniques I had some strong reactions. These days I may only spill a few tears for five minutes and move on.

I have processed a lot of my grief now. It will always be with me, but that is OK. You can’t keep hold of all the happy memories without being aware of the loss.

The story has been posted on Bipolar UK

Photo by Hannah Olinger on Unsplash

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