Listen to The Mighty Podcast episode, “I Have Bipolar Disorder, Now What?” A transcript is provided below. In honor of World Bipolar Day, this episode tackles the lived experience of bipolar disorder. Mighty host Ashley Kristoff is joined by Rudy Caseres, a live-streamer, mental health public speaker, and storytelling event producer, Gabe Howard, a professional speaker, podcast host and author, and Sarah Jickling, a musician, podcaster, aerial artist and mental health advocate, for a discussion on the details that are important to know whether you have the diagnosis or know someone with the disorder. They’ll talk about their different paths to a bipolar diagnosis, the good and bad side of hospitalizations, and their suggestions for ways to create and build support before a moment of crisis. If you’d prefer to listen to this episode on Apple Podcasts, you can do so here. Find out more about this episode’s guests: GabeHoward.com SarahsGoodBadLuck.com RudyCaseres.com Connect on The Mighty: Join Podcast Peeps Download The Mighty App Transcription: Ashley Kristoff Welcome to The Mighty Podcast where we infuse the health space with positivity, humor, and vulnerability. The Mighty is a safe and supportive community here to help you find the people and information you need to navigate your health journey. We’re so excited to spend some time together today. Now let’s get into what the health we are talking about. As always, I’m Ashley, your Mighty host and today I’m joined by three incredible people to dive in today’s topic: bipolar disorder. So we have Rudy Caseres, Sarah Jickling and Gabe Howard here today. So Rudy, why don’t I swing it to you first, give a little bit of background for our audience. Rudy Caseres Hello, hello, my name is Rudy Caseres. I’m @rudy on The Mighty. I’ve been collaborating with The Mighty since about 2017 when I did their ‘What It’s Like to Be Manic‘ video and I’ve been doing live streams ever since then. I was doing every month for a while. I’ve always been grateful for the opportunities that The Mighty has provided me. I was one of their Mental Health Heroes of 2017. And I also recently launched a YouTube channel called ‘Bipolar Untangled’ where I deep dive into all things bipolar and learn just as much as the viewer does. Sarah Jickling Yeah, so my name’s Sarah Jickling. Sometimes I go by ‘Sarah Jickling and Her Good Bad Luck.’ I am a musician and a mental health advocate. And I live with bipolar disorder type two, and like anxiety disorder and OCD and borderline and you know, all those things, too. I’ve collected the alphabet. I also have a podcast actually called ‘Keep it Hush Hush’ about bipolar disorder and stigma. And most of my albums, actually all of my albums, are about mental illness. So in fact, before COVID, I used to tour around to high schools in my area and talk about psychosis and tell my story and sing my songs. Yeah, it’s a big part of my life. Ashley Kristoff Thank you, Sarah, and Gabe, round us out. Gabe Howard Hello everyone my name is Gabe Howard and I live with bipolar disorder. I’ve noticed a theme it’s like that’s why we’re all here. That’s my poor attempt at humor. In my head everybody is laughing. I am the author of ‘Mental Illness is an Asshole and Other Observations.’ I also host a couple of podcasts, one of them for over five years now, ‘Inside Mental Health.’ It’s a great show where I make experts explain high-level topics in a way that my dad can understand. I figure if my dad can understand it, everybody can. And I’m very excited because ‘A Bipolar, a Schizophrenic, and a Podcast’ with my co-host Michelle Hammer is coming back. So I don’t know when this is going to air but it might be out already. It might be coming. You’ll just have to go to ThisEmotionalLife.org/bsp and check out the status on that. But it’s a super cool, 10-episode run. I highly recommend listening because you know, hey, it’s a good podcast. Ashley Kristoff I love it. Well, thank you all and thank you all for being here. Before we get into the meat of our conversation today, I just have a fun little icebreaker to get us started. So I will leave it up to your imagination as to why you’re in the scenario, so that’s on you. If you had to lose one of your five senses —so vision, hearing, touch, smell or taste — which one would you pick to lose and why? Gabe Howard I feel like this is the Kobayashi Maru, like in Star Trek, where I’m just gonna’ hack the system so that I can keep them all and win. No? Nobody envisions me as Captain Kirk? Ashley Kristoff We’re in a situation where gotta pick you just got to do it. You just got to say goodbye to one. Gabe Howard I’m gonna go with smell. I think that’s the one that I use the least. That’s, I mean I know I use it for eating, right? So that’s, yeah, I’m still gonna have to go smell. Ashley Kristoff I support this. That’s my choice as well. Rudy Caseres I was gonna say smell but I’ll go with taste because I want to be one of those people who can like, like smell colors and hear french fries. Sarah Jickling I was also gonna go with smell, you know, I really don’t use it that often and especially in terms of art, which would be my most important thing. But yeah, taste would actually be OK too because honestly, sometimes you just wish that you could just like take a little powder and not have to deal with like making food that tastes good. So it’d be a big load off my plate, literally and figuratively, to just be able to only eat like, Soylent or whatever. So yeah, maybe taste would be good to get rid of. Ashley Kristoff That definitely would make it very convenient if like you didn’t have to taste your food. I went smell because I feel like smell’s the one where it’s the worst. Like, if it’s bad, it’s the worst of them for me. If something smells bad, it’s worse than if something’s like too loud or something has a weird taste, because that can go away real quick. But smell like really lingers in there. And it just, nope. Rudy Caseres That’s why you see people pinch their nose when they have to eat something really bad. Ashley Kristoff Very true. Well, I’m glad no one picked hearing. So we can continue this podcast and actually talk to each other. So let us jump into the meat of our conversation and just because The Mighty does serve a huge community, I do want to give a little bit of context as to what bipolar disorder is, in case people aren’t super familiar with it. So I would say if you picked up a random person on the street, and you ask them what it was, they would probably just say mood swings, and that’s where it would end. Obviously bipolar disorder does have mood swings, emotional highs and lows, but it is a little bit different than a mood swing somebody who doesn’t have bipolar disorder may experience. So with that, you may experience mania, which symptoms of that include like impulsivity or risky behavior. It’s more of that emotional high, where you have increased energy, you may feel euphoric, you may talk a little more quickly, feel invincible, kind of top of the world type feeling. You also have hypomania, which is similar, but just a slightly lesser form, it’s a little bit decreased level of mania. We also have depression, which most people are very familiar with that one, but more lethargic, increased sleep, potentially suicidality, losing interest in activities. And then the final piece here isn’t super a symptom, but it’s the mixed mood, it’s mixing a little bit of each, kind of experiencing that at the same time. And then the last piece here is you may have heard terms like, I know Sarah said bipolar type two when she intro’d herself. So, there’s type one, type two, cyclothymia, there’s not otherwise specified, really, it has to do with how you experience those symptoms, which ones impact you more and in which ways. That being said, so many, so many backgrounds feel free, if I missed anything to add that in. But the first thing I really wanted to talk about is the diagnosis, journey and symptoms. You know every time you look at bipolar disorder, it says it’s one of the harder mental illnesses to diagnose. So I want to kind of just talk through that experience for anyone who is maybe on a similar journey, or is, you know, at that point in which they’re not quite sure.and that might be something that their mental health team is considering. So if anyone wants to kick it off? Sarah Jickling Oh, yeah, for sure. My diagnosis journey was, all I can do sigh, oh it was hard. And there’s a lot of different factors that go into that. When I first started experiencing these different states, I didn’t know anything about bipolar disorder. Eventually, went to my family doctor, she said, “Jave you ever heard of bipolar disorder?” and I was like, “Yes?” and then just sent me on my way, put me on a waitlist for a psychiatrist—I live in Canada. So put me on a waitlist for a psychiatrist, but didn’t really tell me anything else. So I came home being like, “Oh, so I got the diagnosis of crazy. Great.” Basically rejected it, and never ever went back to that doctor. And then for the next, I don’t know, five years, I would run away from anyone who suggested bipolar disorder as the problem. And I really went into more alternative medicine places where people would tell me, “Oh, there’s nothing wrong with you, you just need to change your diet.” or stuff like that. And every time something did go wrong, say I was in depression, I would be put on a waitlist for a psychiatrist. So I would go into hypomania and I would cancel the appointments. Because it’d be like, “Oh, I don’t even remember feeling depressed. So like, there’s nothing wrong with me.” and I’ll cancel the appointment. And this happened so many times, I basically had to skip the waitlist by just going to the emergency room and saying, I’m not leaving until I see a psychiatrist, which, of course, I had to get to rock bottom before I would do that. And that’s when I had this psychiatrist, you know, she talked to me for an hour and then said, maybe on our second visit, “Have you ever heard of bipolar disorder?” and I was like, “Yes.” Just at this point, I accept it. OK, fine. I accept this diagnosis. And by this time, I’d received more information. I was big fan of Maria Bamford and she was talking about bipolar disorder. So it felt like it just kept coming up all the time, even though I tried to escape it. By the time she finally said, “OK, maybe bipolar disorder is where we should look.” I already spent like five or six years just like running from that diagnosis. So I finally accepted it and said, “OK, yeah, That’s what I have. Now what can we do once I’ve accepted this?” Ashley Kristoff Yeah, I think that’s so good too because we talked in a different episode that was around chronic illness about how acceptance is such an important part of whatever journey you’re on because you can’t get better unless you’ve accepted that or not even get better but you can’t manage your symptoms if that’s the case, if you’re not accepting that you are experiencing some of them. So Rudy, Gabe who wants to jump in? Rudy Caseres So for me, I’ve always dealt with mental health issues of some sort, whether it be anxiety and depression. I’ve dealt with catatonic episodes as well, most prominently when I was in the army, which led to my discharge from the army. Thankfully, honorable but it was a very traumatic time in my life, because that was my last hope to make something of myself. And when that floundered, I was very suicidal. I was very, just hopeless. I did not know what to do with my life. And I tried going back into theater, I tried going back into school, nothing, it didn’t seem to work. I was dropping out of classes, dropping out of plays. I had a couple of hospitalizations, involuntary hospitalizations. It wasn’t really until I got involved with this club called Active Minds on my campus, which is a national organization where they have this is just a clubs on campus where they talk about mental health resources, we’ll go to classrooms, share our stories, just try to normalize the conversation, the mental health on college campuses. And I was their president, and I’d never been leader of anything before. I actually thought I was horrible at the job and my therapist kept encouraging me despite my wishes. And somewhere along that path, I developed my first manic episode. And I didn’t know what was going on at first, because I was pretty pretty sure like I just had the depression/anxiety with some catatonic features. This heighten like sense that I can do anything and it’s weird, because with the depression, it felt like I can do nothing that I was this loser. And the mania was just, it overcame me. And it was like no, that the pressure is gone. I started hearing more about mania and I thought like, that kind of sounds like what I’m experiencing, but the way they’re explaining this, it’s bad. They’re saying this in a way to box people in. That you’re manic, which means you’re sick and therefore, you need to be controlled, you need to be taken down a peg, knocked down to your proper level, which is depression, thinking low myself. And so I railed against that at all costs. But eventually, all that negativity coming from outside, it cracked me and I sank into a depression again, it was like the bottom completely fell out and I fell underneath. And it’s weird because I try to explain bipolar as, you’re trying to work between the poles– even though there’s so much in between. I actually don’t like just bipolar, because there’s a lot of middle ground. But it’s,you go from having the mania to where you feel like you can do anything, that you are no longer depressed, that you defeated depression and then you have the crash. The crash will come. And then you go back to feeling like you can’t do anything. And then it’s like the same voice is in your head. It just flips on you whether you like it or not. And you seem to have very little control despite how hard we try as Bipolars’ to try to harness that magic in a bottle. It is so incredibly difficult. Since that crash, I fully embraced bipolar and I’ve had a few manic episodes since then, but like not really anything serious since like 2017. I get to experience the joy of depression 99% of my life, and crippling anxiety and catatonic episodes, but I still fully identify as bipolar. I embrace it, I don’t run away from it. And I love, I love talking about it. That doesn’t mean it’s a walk in the park all the time. It sucks, but I try to make the most of it. I try to live my life as someone who is bipolar, and try to educate others try to explain it in a way where people are not too scared of bipolar. Ashley Kristoff Absolutely and, you know, being bipolar isn’t inherently bad. Having a mental illness isn’t inherently bad. So anything that can be done to break stigma behind it, but really, yeah, bring it into that mainstream of this is really actually what it looks like not how it’s how it’s been described is being such a valuable thing to put out into the world. Definitely. I’m very thankful for all of your advocacy over the years that I’ve known all of you. And then Gabe want you round us out with your story. Gabe Howard I was diagnosed after being committed to a psychiatric hospital. And before then, everything I knew about mental illness was well wrong. And based on misinformation, and I would describe it now as very stigmatizing, like I was now, the person who I run around educating. I believe what my family believes and my family believed what we saw on TV and what we heard from our friends and colleagues, etc. We didn’t really talk about emotions, there was sort of this, what we now call ‘toxic masculinity’ kind of walking around where we had to be tough and where we buried our feelings. We just believed that mental illness was something that happened to bad families. And it was something that happened to other people, and that it was very much a moral value. And I explain all of that, because I do have a good family, I really, really do. The symptoms of bipolar disorder, as Sarah and Rudy have described, can look like a lot of other things, especially in teenagers sleeping 15 hours a day, and staying up all night. That doesn’t sound like a mental illness, that sounds like a teenager that needs help with time management and prioritization. And not wanting to go to school because you’re depressed also looks like just not wanting to go to school. So my parents tried to punish the symptoms out of me. And all of this ends up with Gabe Howard, 25 years old. And coming to the conclusion that I’m just an asshole. Luckily, I did run into somebody who recognized that, hey, there’s something else going on here. She noticed the suicidality, she noticed the suicidal thoughts, and she got me to an emergency room, where as I said, I was committed and then the crash course of bipolar disorder began. There’s not a lot of silver lining in being diagnosed for the very first time with a mental illness at 25, but the ones small silver lining is there’s just an incredible amount of data that they can look at. So I was very fortunate, and I got the correct diagnosis right out of the gate. You know, I didn’t start with depression and then add on mania, or there was just so much information because I had been undiagnosed for so long. Of course, the negative is, I had done so much damage. So much damage to myself, to my relationships, to the people around me, I’d hurt so many people. Even as I described how much damage I did, it could have been so much worse. I mean, I’m still alive, I’m in a hospital, and I have health insurance. So I was even in a good place in the very, very, very bad place that I was in. And that’s that’s really like the shortened TikTok version of my diagnosis story. Ashley Kristoff Yeah, I think that’s really interesting, too, because it’s much, it’s a much different perspective, to end up with that same diagnosis, just because it took still that long time. But that you got that diagnosis immediately, which I feel like doesn’t happen too often. Something that I want to share is I was actually diagnosed with bipolar two months ago so it’s very new to me talking about it. And I’m having a lot of like, we’re at the point where I’m testing out medications right now. And the symptoms that I’m working through to talk coherently right now is fun. That being said, I was misdiagnosed over the years, which is why I didn’t know about it until this year. And it was really, because things got really bad for me. I had moved to the East Coast, I had changed a bunch of things in my life, the suicidal thoughts were increasing to the point where I didn’t feel like I could continue living like that, which is what forced me to then go and talk to people about it, because we had been treating like depression/anxiety symptoms for a handful of years but I wasn’t having any kind of success with managing those symptoms. I hid that very well, I think, but I wasn’t having success with it. It made it very clear that there was something else going on and the depression treatment that I was working on wasn’t working for me. And in fact, it was actually getting worse because of some of the medications I was trying. So that’s basically how we ended up at the diagnosis is my my psychiatrist looked at all these things, and then also knowing that, I feel very fortunate in the fact that I got diagnosed with ADHD first because they tend to be co-morbid potentially conditions. So I think that helped that process between the ADHD and the bipolar diagnosis go a little bit quicker than I think it would have otherwise, just because I really have those depressive symptoms really big. And I would say I definitely experienced hypomania, but it just kind of looks like a good day for me. So it we didn’t we didn’t think anything of it. I know Rudy, you mentioned you got diagnosed with schizophrenia. Did anyone else have a misdiagnosis at the start? Sarah Jickling First I received depression and anxiety as a diagnosis, then bipolar disorder. I rejected that. Then I received borderline as a diagnosis. I received panic disorder. I received then bipolar disorder again and then I was like, ” No” and I got so many different diagnoses. Like having literally two professionals argue with each other about what’s going on, that was very confusing. I had many situations where I would have the psychiatrists tell me one thing, and like a counselor told me something else, especially certain counselors had different beliefs about what bipolar is. And like, it’s so strange, it’s so strange that people can say, “I don’t believe in bipolar disorder.” Like this is not Santa Claus, lwhat are you saying? For people who don’t know, borderline personality disorder, it addresses those kind of like intense mood changes, like from hour-to-hour and the inability to regulate your emotions, which, at one point, I had a psychologist say, “I can diagnose you with by with borderline if you’d like.” He’s like, “I don’t think you fit all the things but if it’s going to help you get into certain programs, I can give you the diagnosis.” I just take the things that I found helpful. I think that bipolar disorder,type two, when that was finally explained to me everything, click, click, click yes. This makes sense, this makes so much sense. And that’s what happened with ADHD this year, as well. It was finally explained to me properly, I was like, “Oh, yes, all those things. I have all the things, I do all those things.” So if if you just start talking about the symptoms of one to a doctor, and then you’ve never seen that doctor again, as you see another doctor and start talking about different symptoms, you will get a bunch of different diagnoses. And I just find take what really fits for you. And ideally see the same doctor over and over again, if you can, because then they will get a bigger picture. Ashley Kristoff Yeah, I have to imagine you’re already dealing with turbulent emotions getting a bunch of different information of like, I don’t, this isn’t helping me either. I don’t know what to do here. There’s just too many things going on. Yeah, and then definitely too I think the, we talked about acceptance, but I think that internalized stigma is is very present just because like I feel like we get bombarded out, like outside of the mental health world where I feel like we can talk about it a little more calmly and holistically. I feel like outside of that world, it’s very hard to talk about it in that way. And so the you almost bring that stigma into hearing this diagnosis, because that’s how the outside world seems to view it is is that very stigmatized piece. Rudy in your diagnosis journey you mentioned catatonic episodes. Can you kind of describe what those are for people who may not be familiar with that term? Rudy Caseres Yeah, the the quick and fast way is, oftentimes people have a fight or flight response in regards to danger. When I was in the army, I couldn’t just flee the army and be AWOL that was just created all kinds of other problems. And I was tired of fighting, I could not fight anymore. I physically mentally just had nothing left in the tank. So I froze, couldn’t fight, couldn’t flight, I froze. The third lesser known F. And it’s not a fun experience, because I could not move my body. I could not talk. I couldn’t even like swallow because I had drool coming out of me. And it was in the dining facility during dinner time. So people were looking at me laughing, making jokes. I had to get picked up out of that my chair and then put onto a stretcher, and then taken to an emergency room where I eventually came to. Some people, they can be catatonic for a very short period of time, some people, it can be a month or so and where they like have to be like medically fed or find ways to get them out of that because they won’t eat or sleep or do anything and then they can die from it. So thankfully, I’ve never had it that extreme. It’s definitely happened at times where I just, I can’t, I don’t know what else to do. Like I can’t even explain what’s going on in my head and so I just freeze. And thankfully, I’m around people now who understand. I’ve been around people in the past where they had no clue what was going on and their only solution was to call 911 and then I had to be taken onto a stretcher again, taken to a psych ward, which is always been a bad experience for me, I would never want to do it again. So thankfully, I’m at a place where even if I am catatonic, and it has happened in the past couple years, I’m not worried that I’m going to be put into an involuntary situation anymore. Ashley Kristoff Definitely. And I know you’re very passionate about talking about involuntary hospitalizations as well. So I would love to just kind of jump into those different experiences, right, because I know, Gabe, you had said that you went to a psychiatric hospital, but those were under much different circumstances than you know, other things that Rudy has experienced. So I’d love to just jump into that topic a little bit. Gabe Howard Inpatient hospitalization, it’s horrible. I don’t think there’s a, it’s traumatizing. Let’s use a word that our, you know, mental health advocacy people love, it is traumatizing. And just because you have a good outcome or something like that, that doesn’t make it not traumatizing. And the example that I always use is emergency surgery, right? You get in a car accident, and they lifeflight you somewhere and you’re like, “What’s going on?” And I’m like, “Sir, we don’t have time to explain it,” they knock you out and then they save your life. And everybody’s like, “Oh my god, you got in this horrible car accident, we had to perform emergency surgery, and because of that, you didn’t bleed out on the pavement,” and you’re like, “I’m terrified, and I’m scared.” And then they look at you and say, “But it’s for your own good.” And nobody would ever do that. They be like this horrible traumatic thing happen to you and I understand why you’re scared, and you don’t know what’s going on. And they have to explain it to you. I can already see my mom rubbing my head. And everybody loves you. And just everybody’s giving you, you know, sympathy and casseroles. And yet, for some reason, if you need that same emergency assistance inmental health, it’s like, “Well, it’s for your own good. Well, we’re supposed to do?” There’s no rubbing of the head, there’s no casserole, there’s no explanation, there’s no trying to reduce the trauma. There’s just ‘it’s for your own good.’ And it leaves me in a very, very difficult position as an advocate. Did being committed to a psychiatric hospital save Gabe Howard’s life? 100%. I’d be dead if it wasn’t for it, I am positive of this. Could they have done so much more when I got out to make me understand what happened, why I was locked in, why they were doing these things? I went years thinking that I was locked in this room because society was afraid of me and hated me until somebody finally explained, “Look, you were suicidal, we had to keep sharp objects away from you and that’s why you were locked in. It’s so we could control the environment and make sure that you couldn’t get a hold of anything that you could use to hurt yourself. And of course, you were in there because you were trying to hurt yourself.” Well, that’s a very different feeling. Being told that, that they’re trying to keep instruments away from you that you may use to hurt yourself has a very different vibe from everybody hates you so we’ve locked you in this room and thrown away the key. Why did I have to wait three years, four years, five years, and become a top level mental health advocate to learn that? I mean, really, why? It’s not fair. You shouldn’t have to learn that by starting a blog and starting a podcast and advocating eight hours a day and working with Rudy and Sarah and Ashley and all the people that I work with before somebody finally says, “Hey, Gabe, did you think about it from this perspective?” Hmm, no, no, I didn’t. It’s not fair. It’s just the phrase, ‘it’s for your own good’ should be stricken from the record. I don’t give a rat’s ass if it’s for my own good, it hurt me. And I am in pain. And I deserve care for that. It really is something that we don’t spend a lot of time on. We just kind of pat people on the head and tell them that they’re OK. But again, I do struggle because it did in fact, save my life. I just wish I could have gotten better, or any, aftercare. Ashley Kristoff Absolutely. And I think it’s also too, don’t remember if I heard this by recording another episode or something else, because memory is great. They’re trying to give you the care that’s making them the most comfortable, not the care that’s like compassionate, and is actually the most helpful. So that resonated with what you were saying. Sarah Jickling Just something Gabe said really resonated with me as well. Every time I either went to the hospital voluntarily or was taken there by police officers. And I remember, first time that that happened, I ran from them, I was screaming I was knocking on my sister’s door because she lived close to me being like, “Don’t let them take me, don’t let them take me. I’m so scared.” And the more you struggle, the more they make you feel like a criminal like you are under arrest. And now I’m in the emergency room surrounded by lots and lots of different things that are happening to lots of different people. Having an emergency nurse who is, I’m sure has seen horrible things and just doesn’t have time for me so every time I, you know, scream, she calls security. And I have security guards like putting me back in the bed. I was never like, put into the psych ward and here’s why. So eventually, you know, you’re in the emergency room for eight hours. They have monitor you like for me, they’re like, “OK, you’re OK. You didn’t take enough pills to do anything horrible.” The Psych nurse comes to you and says, “OK, we’re gonna send you home because you don’t want to go to the psych ward, that is a really bad place. Yeah, I was suicidal. And I said, “Oh, no, I feel fine. I’m not going to do it again, I swear.” Like I totally planned on doing it again. I was just like, I need to get out of here and the psych nurses were saying you don’t want to go there. It’s a really bad place. So please leave. It’s amazing to me, that’s how we care for people who are having, in mental distress and potentially could, like I could have gone home and died. I totally understand why my friends kept calling the police. I think I maybe would have done the same thing. And that’s the thing with what Gabe was saying. I don’t know what else to do. It was horrible and yet, when I’m listening to teenagers when I would go on my tours to high school saying, “I’m worried about my brother. I think he’s gonna do something really bad. And I don’t know what to do.” I just have to say, like, “If you’re really worried call 911” knowing that it’s going to be traumatic, and it’s going to be awful. But at the same time, I don’t know what this teenage girl can do to stop her brother from doing something really dangerous. And the fact that that’s our only option is so awful. And I just wish that there was like a separate emergency room for mental health things. Where my friend put it really lovely, really well, where she’s like, I wish that there was like a separate emergency room that looked like Central Perk from Friends. And just like, low lighting, couches, everything’s OK. And then like having a psych ward, where people actually are, where the nurses aren’t like, “That’s the bad place. You don’t want to go to the bad place.” You know but, “Oh, no, we can take care of you, make sure that you’re safe, and it’s going to be OK.” I think that so many things need to change. I mean, I’m glad I’m not in a straight jacket in an insane asylum but that’s a very low bar. So we’ve got to do better. Ashley Kristoff Yeah, I feel like you you shouldn’t be in this situation where you have to decide a psych ward or feeling suicidal and you can’t decide which one’s worse. Like, that shouldn’t be a conversation that you need to have with yourself or with anyone. Rudy Caseres Yeah, one of one of the more annoying things about being a psych ward patient and also manic is that you’re often treated like you’re “crazy” and no one, if you’re manic, you don’t think that you’re crazy. You think everyone else is. It can be very counterproductive if you’re a mental health professional, and someone tells you that they’re Superman, or they have magic powers, and be like, “OK, whatever, get back over there. Take your medicine and everything.” If you’ve ever talked to someone who works a crisis line, especially a peer-support line, you’re told to not completely invalidate someone’s delusions, no matter if you think they are completely delusional, completely wrong, completely incorrect. You as someone who’s trying to provide support, you can’t just say like, “You don’t really believe that, right?” That is, that is not going to work and yet that happens so many times in psych wards. I’ve seen it myself, I’ve actually have gone into psych wards to do presentations, to share my own story which is always an interesting experience. But I see with my own eyes of how little respect people who are experiencing mania and psychosis are given in psych wards. And that’s not going to help if your end goal is to get that person to a better place where they’re no longer a danger to themselves or others, completely validating their experience is not the way to go. Gabe Howard Along those same lines people always say to me, because Rudy and I have the same job just in different states. And they’re like, “Oh, so you should just agree with people? Somebody tells you that there’s a dragon following them around, to not invalidate them? You should just agree that you to see a dragon?” And I always laugh a little because I’m like, “No, why are there only two options, agree with the person or tell them they’re wrong?” This is what people believe. There’s only two options. Nobody feels this way when dealing with significant others or their friends or children, etc. When somebody says, “Hey, I see a dragon.” You don’t have to agree with them. Just say, “How’s that making you feel? Are you worried about the dragon?” None of these things say that you agree with them. You’re asking them questions and you’re following up and you’re engaging. And look, telling somebody who sees a dragon that there’s no dragon is stupid. And here’s why–they see the dragon. You tell them that there is no dragon. They do not believe you. The conversation is over. They think you’re a liar because who are they going to believe, you, or their lying eyes? And that, “Well there’s no dragons.” Yeah, stop it, you’re supposed to be the person who is of sound mind. It’s just mind numbing. It’s this mind numbing circular logic that the people in charge of helping us do not do what will actually help us and instead decide to plant their flag on logic. These are the things that we need to isolate and change. I do believe that the people providing us care are good people, I’m not trying to throw providers under the bus. I understand that they have many, many, many issues as well. But their issues cannot be more important than the patient issues. They are there to serve the patients and sometimes I feel like it’s my job to reassure them that they’re doing OK. And maybe it is, but it’s also their job to make sure I am actually doing OK. And that’s a conversation that I think gets buried a lot. Now I want to dragon, like so bad. Let’s get a dragon guys. Rudy Caseres I’m nodding my head ferociously for those listening at home. Gabe Howard If we get a big enough dragon, the four of can ride it. Ashley Kristoff I literally got a dragon yesterday. I went to Build-a-Bear yesterday and they had a Toothless and I had to get it. I wasn’t planning on getting anything, we had taken my friend as a surprise. because she had talked about going, there was a Toothless. So I now have a dragon. Rudy Caseres Yeah OK. Gabe Howard I don’t believe you. Rudy Caseres Whatever you say Ashley. Gabe Howard Sure. No, right? Rudy Caseres The point is not necessarily whether a delusion or a vision or a voice is “real or not,” it is about what is it in reaction to. What is the underlying story behind this? What caused this? This doesn’t appear out of thin air and if you can steer the conversation towards that, you’ll have a lot better productive output than just going around in circles telling the person is wrong. Ashley Kristoff And too I want to note, because you said like, yeah, the doctors can be great people but it is that systemic issue versus like a personal issue. Even so there are so many professionals who are like, “I want to do differently, and I want to do more,” but they also are restricted in that way too by who they’re being employed by, by maybe the board who gives them their certifications. And that’s more frustrating, almost, because they want to give you that care, and they can’t, so they aren’t in a situation where they can actually give you the appropriate care you need. Sarah Jickling I hope that in the future our psychiatric wards are better. And I know because the best psychiatrist I had was the youngest psychiatrist I ever had and I feel like the education is changing. It is like Gabe said, small changes. You know, there’s gonna be new medication invented, discovered. A lot of this stuff was not even discussed 100 years ago. So we are really, really behind in the medical community when it comes to all this stuff with our brain and also it’s people don’t know a lot about the brain. So I just have a lot of hope for the future and when people tell me, “Oh, you know, doctors don’t want you to know this. Doctors are being paid off by these people.” I’m saying no, they’re trying their best and the people who are telling you they have the answers, those people are lying, because there are no answers and there is no good thing to do at this time. It sucks but yeah, it’s the best we’ve got right now and I just, my thing is don’t die. What can we do to make sure that you don’t die and you don’t hurt anyone else? And unfortunately, these are the things they do. Ashley Kristoff I do want to swap to that support side here is how can we support our friends, family loved ones who are bipolar, and, you know, maybe are having suicidal lows, or you know, they’re in a place where they’re either going to cause danger to themselves or others. Sarah Jickling I think the best thing to do in terms of support is to be there and just continue to say, “I’m here.” Like an even, I had one friend who just came and sat with me for an entire day. And like she didn’t even say anything and that was helpful. Making somebody food, like doing these things that we can’t do when we’re in a really bad place. That’s a really great support thing as well. And also remembering when the people are seemingly well, they still have those mental illnesses, and not being like “Wow, well you’re so lazy, because you’re not doing X, Y and Zed,” but being like, “oh my gosh, amazing! You haven’t self harmed in a while. You ate food. Good job!” Instead of basically immediately forgetting that the person has been struggling as soon as they stopped physically showing the struggle. For me, that’s the number one thing. Gabe Howard If somebody is an immediate danger to themselves or others, obviously it is now left your hands. I want to be clear, we’re not superheroes, we’re not doctors, we’re not medical practitioners. And we have to remember the safety of our loved ones and understand that sometimes the worst case scenario is upon us. The crisis is here. It’s time to call for backup, right? We want to be very present of that. We want to know that just because we mean well, or that we’re friends that we love people doesn’t mean that we have all the answers. And we want to feel empowered to call, you know, for help. One of the things that I think about is a fire drill, right? I was in school for 18 years, and I had more fire drills than I can count. Listen, the building never caught on fire, it never caught on fire. But we had all these fire drills before the building caught on fire when there was absolutely no danger. And we learned what to do. And we learned where to go. And we learned how to check in. And I feel very confident even as a 45-year-old man who hasn’t been in school for 30 years, that of that building would have caught on fire, we all would have got out. Because we practice it so much. We need to do this in mental health. It is like Sarah said, so often, we only want to talk about mental illness when there is a crisis. This is literally like figuring out how to get out of a burning building. While the building is on fire. It’s the worst time to discuss it. So normalize, having these discussions and figuring out the crisis plan when there’s no crisis. That way, when you get to that point where it’s out of your hands, you can literally do what Sarah, Rudy, Ashley want, because you’ve already discussed it. You know who to call, you know where to go you, you know what happens. Also, because of these discussions, you can really get there before, not all the time, it’s not perfect, but you know, perhaps I can get there before Sarah, Rudy, Ashley, hit crisis,. I can say, “Hey, I can see that you’re trending down, because it’s so normal that we discuss it, I can tell that look, it’s just a few days before you hit the danger zone, let’s do something now.” And Rudy’s like, “Look, I trust you, because we discuss this all the time.” Sarah’s like, “I get it.” Ashley’s like, “I get it.” And all of a sudden, you know, we’re preventing the fire because we see that there is a hazard versus, you know, just being inflamed. Look, my grandma says a pound of, what is it, an ounce of prevention is worth a pound of cure. It’s an old timey saying, but I think it tracks. Ashley Kristoff I like too that you said too is note when you can’t help because that’s very important. Don’t try to help somebody if you don’t actually have the capability to do so. Rudy Caseres I love that and I will say that too often people think that because they’re not a trained professional, that they’re not capable of providing peer-to-peer support. And I try to rail against that, that anyone is capable of offering support, because oftentimes, our minds are warped on what support looks like. It looks like that we should be telling someone what to do, we should be trying to cure them, we should try to save them. Oftentimes, we don’t give people choices. We don’t give them agency. Simple things like asking someone if they want to sit down or stand up when you talk to them or go somewhere less quiet. That can be huge. Just little things like that, that seem like they don’t make like a big deal can really, really help because you want to get to a point where you’re helping someone before they get to that point where they’re over the limit, where they’re in need of emergency support. Oftentimes, we don’t do that enough. We just wait until that person is at the cliff or on the bridge, and so much we can do. There’s so much we can do to help people out way before that. And that’s what I am a big proponent of. Ashley Kristoff Yeah, I love that. And I do want to, we did ask the community a question ahead of this episode so I would love to get like a one sentence response to this if you can. So we asked, “If you could go back in time, what advice would you give your past self when you got that initial diagnosis?” I do want to share one brief one from the community and one slightly longer one. So the first one was, “Get out of retail,” which just was great. But the other one I wanted to share was, This will change your life, but you will grow and learn to take care of yourself” and I thought that was just a very good speaking of that acceptance piece, right? Its like knowing this, you know, having a label can just be really helpful more than it can be like you need the definition. So sometimes just having that knowledge is sometimes enough to at least get you to that point in which you can take care of yourself. So does anyone have an answer of what you would tell your past self? Sarah Jickling I think I would say finding the problem means we can find the solution. So now that we’ve named the problem, now we can find a solution. We can find a way out. Gabe Howard Mine would probably be other people have been where you are and they are OK now. Rudy Caseres I would say to not run away from bipolar or any mental illness diagnosis. To embrace it in a way where it is part of you. It’s not all of you, but you’re going to find a way to make this into a positive, and you’re going to be a badass bipolar mental health advocate. Ashley Kristoff Love that. It’s a great way to end that part. So, I do you want to jump into our Self-Care Corner before we wrap things up. So I wanted to ask what kind of boring self-care do you do to either help prevent your down swings or what does the boring self-care look like that you do to either manage symptoms or kind of those episodes. Gabe Howard Sleep hygiene. I get made fun of for bringing this up so often. As go sleep, as goes Gabe’s moods. Sleep hygiene is the most boring thing ever. In a nutshell, it’s this, go to bed and get up at the same time. Only use your bed for sleep and sex. That means leave your devices, don’t watch TV, and set up a place for sleep. That way when you climb into bed, your body’s like well, there’s nothing to do here but sleep. And it just helps. And if you end up with a symptom where you do stay up all night, remember, get up at the same time. So yeah, that’s going to be a rough day but you haven’t reversed your sleep cycle for the next month. And pay attention to it. If you have trouble sleeping for too long that is a fair symptom to report to your doctor. So many people think that sleep is laziness, it’s not. Sleep is necessary. It is oxygen. And especially for somebody with bipolar disorder, going to bed at the same time getting up at the same time and creating all of these rituals around sleep has literally made my life 90x better. The 10% that it’s made worse is being mocked for just being so into sleep. Sarah Jickling I think that for me movement, I have to move. I’m a pole dancer and a pole instructor now. I do a lot of movement every day. But even if I am not going to go dance or do circus stuff, I have like this little thing that helps me go upside down. It helps me do handstands. And going upside down, if I’m if I’m freaking out, I go upside down. It just it helps so much. Or just even to do like a little dance or jumping jacks. I have to move every day. It helps so much it’s ridiculous. Rudy Caseres I listened to Gabe Howard podcasts, Sarah Jickling albums and Ashley ASMR streams. Ashley Kristoff I haven’t done one of those in a long time. Gabe Howard I’m sad that that’s the ridiculously boring thing that he does. Wasn’t that the question? What’s the mundane? Boring? Wow. Wow. Ashley Kristoff Oh yeah, that’s true! Rudy Caseres I mean, but in all seriousness though, oftentimes people, they don’t like being in their own head. And they like to shut things off or always have noise going on in the background. I like to be introspective. I, because when I’m depressed or when I’m manic, there’s something missing. in my life, especially with depression. There’s some need not being met. And I don’t always recognize that if I’m just constantly thinking about what I’m going to what I’m going to do next or like are always on my phone, or just constantly just like hyper connected, I have to just be completely offline, whether that means like going for a hike, or going for a drive through the mountains or something or by the coast and just be in my thoughts and really try to pay attention. What am I missing? Why am I depressed, there’s a reason behind it, it’s not always obvious. And when I can get the root of that, I can start working on myself. That doesn’t necessarily mean I’m no longer depressed, but I at least have a reason for it and a reason to work on something. Because when I’m working on something I can be depressed, it doesn’t really matter. But I want to have that meaning and that’s something that people don’t understand is that you can still be depressed every day and still have a meaning in life. Ashley Kristoff Absolutely. And my answer is honestly very similar to Sarah’s where I’ve found that I do need to exercise regularly, almost every day if I can, because I need to get my heart rate up every day. Because that helps with the anxious thoughts, which I find really compound my depressive symptoms a lot of the time. It’s like I get myself so worked up that a lot of the time it turns into depressive symptoms because I’ve gotten myself so worked up over something. So being able to even just clear my head with that significantly helps that other area as well. Final question I have for everyone here is what made you feel Mighty this week? I will start while you think of some answers. I had a great weekend, which I don’t, a lot of times I feel the weekends too short and I don’t get the rest and such that I need out of it, and I just had a really great weekend. And I’m just very happy about that. So that’s what made me feel Mighty this week. Rudy Caseres I’ll go first for once. I’m here right now in Delaware with my wife and her parents. And it was good timing because I was feeling very overwhelmed and missing that purpose in life. And being here, it’s been helpful to get out of that frame of mind because I can be helpful to my in-laws. I can help them get things or even I’m driving them around tonight. I can help with their dog, I can help around the house and do menial tasks, which sounds kind of boring, but for me, it it helps that I’m like being of use to people and being productive and getting out of that like sad, poor me zone. Sarah Jickling For me, this week, my podcast co-host, who also has bipolar disorder, went to a dark, dark place and I didn’t hear from her for many days. I did and she said, “You know, I haven’t left my bed. I’m not doing well.” And I convinced her to come with me to a twerking class. And we twerked. And she said, “I’ve never felt this good. I haven’t felt this good in so long. This made me feel so much better.” And I was like, yes, twerk is therapy and I got somebody else to do it with me. Ashley Kristoff It is surprising sometimes the things that can genuinely increase our mood. So I just, I love that. That is, that’s great. Gabe Howard The thing that made me feel Mighty this week is on Saturday, I watched my three-year-old granddaughter the entire day. Now if you’ve ever spent an entire day with a three year old, it is a special kind of hell. And I got bored. And I said to her, “Knock, knock” and she said, “Come in.” And I said, “No, it’s knock knock, you have to say ‘who’s there?'” And she goes, “Grandpa, I know that it’s you.” And I said, “No, no, it’s a joke.” And she goes, “Grandpa you’re not a joke.” I don’t know why, but I gotta tell you, it was awesome. I felt like a million bucks. Because of course I was smarter than a three-year-old. Ashley Kristoff Also, kids are so unfiltered so it really is a genuine compliment from a child because they will say literally anything. Gabe Howard They will and she just looked at me she’s like, “Why are you so stupid? You knocked, I said come in. This is over. Also, there’s not a door.” I really felt like she had this look on her face like if she knew the word ‘dumbass,’ she would have called me that. But her being three probably saved me on that one. But it was a nice moment. And also spending the day with her was was truly, truly a nice moment as well. Her going home made me feel very Mighty, and thankful. Ashley Kristoff All right, before we wrap things up, let’s start with you Gabe, do you have, how can people find you? If you want to share anything about your work. Gabe Howard Yeah, please head over to GabeHoward.com, you can find everything about me there. I wrote the book ‘Mental Illness is an Asshole and Other Observations” which of course is available on Amazon, because everything in the entire world is available on Amazon. But if you want me to sign it and throw in free swag, go to GabeHoward.com and order it there. Finally, I really really want to plug ‘A Bipolar, a Schizophrenic, and a Podcast.’ It was a super popular podcast that ended all the way back in 2019. And we’re bringing it back for 10 episodes so sincerely check it out. Just go to ThisEmotionalLife.org/bsp or search for ‘A Bipolar, a Schizophrenic, and a Podcast’ on your favorite podcast player and look for the the little icon-y thingy that has Gabe Howard and Michelle Hammer on it. Which of course you know what we look like. I mean, that’s just, it’d be ridiculous for you not given our extraordinarily high level of fame. So you probably want to start at the website, ThisEmotionalLife.org/bsp. Please check it out. It’s really, really cool. Ashley Kristoff Thank you, Gabe. Sarah, let’s go to you. Sarah Jickling So my music is everywhere that you can stream music, literally everywhere. So if you look up Sarah Jickling which rhymes with ‘tickling’ and ‘pickling’ but with a “J” it will be under ‘Sarah Jickling and Her Good Bad Luck’ and you can listen to my albums there. I would love that. And also I have started a podcast with my friend, it’s called ‘Keep it Hush Hush with Sarah and Jessica’ so you can also find that on all of the streaming sites and on SarahsGoodBadLuck.com And there’s another podcast called ‘Keep It Hush Hush’ that’s about BDSM, so it’s not that one. It’s the one about bipolar disorder. A shley Kristoff Thank you, Sarah! And Rudy. Rudy Caseres I own Sarah’s previous two albums and they are very good. I always love it when they come on shuffle mode when I’m listening to music and it’s like, oh, that’s Sarah’s song that’s so highly recommend it. I also have worked with Gabe quite a few times in the past, we’ve spoken at events, we’ve done podcast together, we’ve done live streams together. So great guy, go check him out. I am @rudy on The Mighty, you can read some my stuff. I wrote a piece that created quite a stir a couple years ago called ‘I’m Bipolar and Don’t Want to be Cured.’ I’m also, best place is also RudyCaseres.com. I know that’s hard to spell, but it’ll be in the show notes, don’t worry about it, we’ll take care of you. My my new YouTube channel, ‘Bipolar Untangled’ is not cool enough to have a custom URL yet, So go to Youtube.com/RudyCaseres and the there’ll be a click through link to go to my ‘Bipolar Untangled’ channel. You can also see other videos that I’ve done, including past Mighty interviews where I got to interview Maria Bamford at The Mighty offices, and some of my keynote speeches as well. I am @RudyCaseres on Twitter and Instagram. Those are probably all the greatest hits. But if you want to contact me go to RudyCaseres.com, there is the contact sheet. So if you want to collaborate or if you have an event that you’re looking for a speaker, and Gabe has already declined, by all means. Ashley Kristoff Love it, awesome! So thank you, Rudy. Thank you, Sarah. Thank you, Gabe, for being here today. And I know all of you do talk about mental health a lot but I do just want to thank you for opening up, being vulnerable, and just sharing your experiences with the community because, you know as you said about suicide talking about this, in general is what makes progress and it’s what helps people understand things better and get more competent care where we need it. Thank you for listening to The Mighty Podcast. If you want to continue this conversation, head over to TheMighty.com or download The Mighty app to become part of our community. We’d love for you to give us a rating and review on Apple Podcasts, follow us on Spotify, or, if you’re listening directly on The Mighty, give this page a heart. Join us on our next episode and Stay Mighty.