Dear Mom, Dear Dad, “I Cannot Only Survive, But Flourish”

A woman’s heartfelt letter to her parents about their struggles with her bipolar disorder.

Well I’m 16/or 19/or 24 years old now and as we all plainly know, I’m bipolar (because of everything that’s happened this year/or two years ago/or back when I was in high school). And there’s a few things I’d like you to know, things I can’t imagine actually TELLING you because I’m too sensitive/or you’re too sensitive/or the things are too sensitive, but here goes:

First of all, I know you’re worried about me. I know because you have that look on your face when you see me, that look, those probing, searching eyes, scrunched lips, tight look. I know because you still ask me if I’m still taking my meds, even if we’re not talking about the bipolar stuff (on the off chance that we’re not talking about the bipolar stuff, because we seem to always talk about the bipolar stuff when we talk). So just so you know. I know that you’re worried about me. That I’ll get sick again. That I look like I’ve put on a few. That my friends are not the kind of friends you’d pick. That this period of good health and relative calm is just that. A period. To be followed by another disaster. That your faces have already begun preparing for this. And since this is an imaginary letter that I never have to send to you, I would like to ask you to express confidence in me, or at least in the parts of me that you still have confidence in. Regularly. More often that you express concern. Way more often. I’m a person—not just this diagnosis, not just your little time bomb.

Second, I’m worried about me, too. I won’t tell you that. But I am. So know it. And as much as you may think that you feel everything that I feel and that my pain is your pain, well it’s not. I need to create an existence that is safe and fun and inspiring, one that has a back up plan in case I get sick, sure, but one that has fifty times the amount of hopes for all the things I’ll do when I’m well. I need help with all of that but I need to do a lot of it on my own or else it won’t count, won’t feel real, won’t last. It won’t be mine.

How much help should you give me? I don’t honestly know. But there’s a place between smothering and abandonment that we need to find together.

..even if we’re not talking about the bipolar stuff (on the off chance that we’re not talking about the bipolar stuff, because we seem to always talk about the bipolar stuff when we talk.

Third, don’t make ME worry about YOU. Got it? Don’t make me worried about how you’re reacting to me. You be steady, warm, reassuring, and I’ll be me. To you. With more honesty. Don’t become someone I have to lie to if things are hard. Be someone I can tell the truth to.

Fourth, get some help. Yes, you. Get some help. I know I’m the “sick kid” but with the amount of stress we’ve all been through and everything else you are experiencing, I think you should get help too. Read some books on the subject. And get therapy. Please. My goodness, no offense, but you need therapy. Start becoming more steady and balanced and relaxed. You can’t IMAGINE how much this will help me.

Fifth, you wonder how much space to give me and I honestly don’t know what to tell you. The bad news is I have been traumatized by what I have been through and I continue to live day to day in a culture filled with stigma. Sometimes I feel great, and sometimes I fall apart all over again. If I’m a drug addict or an alcoholic I need to be treated as such and put in a rehabilitation program. But otherwise, if I’m a good bipolar kid trying my best to have a real life, the good news is I really have a shot.

I’ve done my share of research which all says I cannot only survive, but flourish. Treatmentreally can work for bipolar people. So you guys have to position yourselves and reposition yourselves and be both flexible and firm for me. And then, I can freely look to you for support and guidance and build an independent life that makes sense to me.

And oh yeah, one more thing I would tell you if we were really communicating closely is that I love you. I really do. I  don’t say it or show it often enough but I do love you.

If I could make one wish come true, more than anything else in the world, especially after everything we’ve been through together, I wish I could make a life for myself that would make you proud to be my parents. In my own way, I am working on it everyday. If you didn’t know that, I hope you know it now.

SOUNDOFF! Psychiatrists & Therapists

What do you like most about your psychiatrist or therapist, or what really bugs you the most?

What I like most about my psychiatrist and therapist is that they both take the time to really listen to what I tell them. They are very compassionate and supportive. They treat me as an individual whom they want to help, and not just another dollar figure.


—Name withheld, Spokane, WA

I most like the way my psychiatrist and therapist work with me, allowing my input regarding medications and therapy. I do not like that my meds management is handled primarily by my psychiatrist’s nurse practitioner. Appointments with my psychiatrist are few and far between.
—C. W.

I’d like to discuss my 12-year-old son’s team. His therapist and psychiatrist work together. Their philosophy is to combine evidence-based research and determining values, beliefs, and lifestyle of individual patients to create individualized, successful treatment plans. During our first appointment, I was impressed when I was screened for depression, knowing that it is not uncommon for the main caretaker of a special needs child to suffer from depression. I have never felt rushed during an appointment. My concerns are never undermined, and our psychiatrist welcomes ideas that I have found in my own research. Our psychiatrist returns calls the same day, and answers emergency calls within minutes, 24/7. He is on staff at a wonderful child/adolescent psychiatric hospital. When my son has needed hospitalization, our psychiatrist has been the attending doctor and his therapist also sees him in the hospital. Both have been actively involved in seeing that my son receives an appropriate Individualized Education Plan at school. Most importantly, our psychiatrist knows how to successfully treat bipolar disorder. Our team is awesome!
—J. E., Delavan, WI

I recently changed to a new psychiatrist. I appreciate his ability to listen. Although he does not have bipolar disorder and cannot feel what we go through, I know he takes me seriously when I tell him that I suffer. That understanding has to be there. The second part of your question applies to all the psychiatrists in my experience. They need to ask more questions. Because they are so used to our doing most of the talking, they almost plan for that [lack of two-way communication], except when we are in the depressed state. I would like them to ask how I feel. When I answer, I would like them to reply, “Why?” I would like to hear what they have learned about new research on bipolar and the various treatments and medications. All too frequently, the conversations are one-sided or perfunctory in nature. Psychiatrists need to laugh once in awhile. We are people with emotions and we like to laugh, too. We do appreciate their professionalism, but a human interaction with the patient is always nice—and much appreciated.
—Name Withheld, Portland, OR

I now have a wonderful and caring counselor who cares about my safety and well-being. Before being diagnosed with bipolar, I was misdiagnosed as having depression for most of my adult life. During my “mania,” I was always able to keep a job and have my own apartment and car. So doctors never realized I was bipolar. I’ve been seeing my counselor, Michele Bauman, for about 18 months. Recently, during a very rough time, I was alone and isolated with no phone in a small town. Suicide was all I thought about until my counselor helped me get into a group home in Buffalo, where I’m living now. Michele is helping me get my own apartment near the clinic where I go for activities and group counseling. She is the most hardworking and caring counselor I know. I want to thank her for doing so much for me. So, thank you, Michele.
—Name withheld, Buffalo, NY

We love our psychiatrist. He is up to date on all medications and conservative on dosages in treating two of our children for bipolar disorder. He also has a great sense of humor and is very compassionate. He is available by phone 24/7 and responds quickly. It has taken our family six years of searching to find this wonderful man. We had been to eight different psychiatrists until we found Dr. Peter Ampudia a year ago. As for a therapist, we have found that not many are knowledgeable regarding bipolar disorder in children. At this time, our family is not seeing a therapist because we just need a break from the “search and trial” period. Dr. Ampudia has been there for us as our therapist. We are still searching [for a therapist], however.
—P. B., Manhattan Beach, CA

Making the Most of Therapy

The whole therapeutic process can seem daunting to someone newly-diagnosed with bipolar disorder, but we’re here to tell you the ins and outs of managing it

I remember the week I was diagnosed with bipolar disorder. I was sick and scared and had no idea how this diagnosis would change my life. I got out of the day program at the hospital with a bag of pills and an appointment with a psychiatrist. We had an hour for our first meeting, which I thought was great, and then I was set up for a 20-minute session with the doctor per week! How could I manage this illness on such a short amount of time? I was just diagnosed! I hardly knew what the illness meant, much less how to treat it. The medications were making me sick and my mood swings were getting worse and worse. I know now that my doctor was under strict time restrictions from her hospital, but at the time I felt like I could not treat this illness on my own without seeing her more often.

Many people with bipolar disorder get frustrated because of the fact that they typically get only 15- to 20-minute sessions to talk with their doctor at their scheduled appointment. Does this happen to you? This can lead to feeling rushed when you get to the appointment, as well as feeling worried that you and your doctor can’t make the most of the visits. This column will cover a few of the obstacles you may face when you’re sick and need to get as much as possible from your limited appointment. The more communication and organizational skills you can learn, the more you can get from your appointments. And the more you get from your appointments, the more skills you will have to help you manage the illness between office visits.

When your doctor’s time is limited

The hardest thing for me is the short time I get to see my doctor. When I see him for 20 minutes, I get flustered and can’t remember what I want to say. All we do is talk about medications anyway. It seems the time just flies by and then I have to wait two weeks for my next appointment.

Time seems to be the biggest struggle people face when trying to get helpful treatment for bipolar disorder. We can be sick every day and yet we see the people who are supposed to help us relatively rarely. Luckily, there are options when dealing with this problem.

Prepare ahead for your appointments.
Try to stay calm and focused.
This is a good time to have a list of what you want to talk about.
Be clear on what you need, even if you feel too sick to talk.
Respect the fact that your doctor probably didn’t choose this time limit and would like to see you more.
Learn to voice your concerns. Ask your doctor how your appointments might be more effective.
You also have the option to change doctors.
Considering that most of us don’t have an option when it comes to the amount of time we see our doctor, developing as many coping skills as possible is essential.

When the issue is communication

When is my doctor going to listen to me? The medications aren’t working. I think I’m sicker than I was without them. What are my options? Why won’t he help me? I ask for more ideas and my doctor just looks at me like I don’t know what I’m talking about. I know he knows more about the illness technically, but I think I’m a pretty good judge on what it feels like and what I need. How can I get help when I see him once a month?

The more calm and prepared you can be, the better chance you have of changing your doctor visits into something that works for you.

When you’re sick and time is so limited, you may feel that the last thing you need is a doctor who doesn’t seem to listen, writes out another prescription, and minimizes your concerns about side effects (sometimes saying, “Let’s just give it more time”).

I’ve received many letters on my Web site from people complaining about their doctors. Here’s a communication tip for this difficult situation. Try saying this to your doctor (in a nice way of course):

I understand the time limitations you have when you see patients. But I’m frustrated and sick and can’t manage this illness alone. I see you because I know you can help me. How can we communicate better?

Whew! This is a tough one, but your options might be tougher. Once you’ve said what you have to say, it’s done and there is a chance your short visits can be so much more effective. Your doctor may be unaware that you are frustrated. Many people sometimes feel intimidated by their physicians and psychiatrists.

Talking with healthcare professionals

The more calm and prepared you can be, the better chance you have of changing your doctor visits into something that works for you. Even if you’re quite sick, there is still the “well you” in there who can talk rationally—you just have to pull it out of yourself.

We live in an overburdened medical system. Fewer people are going into the field of psychiatry. More general doctors are treating bipolar disorder. Their time is often limited by HMOs. The more you understand and accept this, the less frustrated you can be.
Make effective use of your office visits.
Have a clear list of what you need to talk about. Let your doctor read this list so you don’t have to spend so much time talking.
Try not to be too needy. Spread out your needs so you don’t overwhelm your doctor.
Turn to people who seem the most willing to help. If you need to make a change, ask others and find a doctor who fits your style.

Get more from your office visits

Use tips from books and magazines such as this one that offer tools that help you stay stable between doctor’s appointments.
Check out the Internet.
Help your family and friends to understand what you go through so that they can be a support between the appointments.
When you bring strong communication skills to your office visits, you can at least feel you have done all you can to get the help you need. We all have a tough time with these time restrictions. Over the years since my diagnosis, I’ve learned to manage this illness on my own—in between seeing my doctor. It was a long journey and may be a long one for you, but you can do it as well.

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The heart of the 20-minute dilemma

Shortened medication visits are generally decisions driven by insurance issues, explains James Waxmonsky, MD, assistant professor of psychiatry, University at Buffalo School of Medicine and Biomedical Sciences, and attending physician at the Women and Children’s Hospital in Buffalo, New York. “Insurers have largely elected to pay separately for medication checks and differentiate them from therapy or other types of specialty mental health interventions, such as family therapy,” says Dr. Waxmonsky.

“The insurer’s expectation is that the med visit is really supposed to address medication only—which is unrealistic, as you have to assess a patient, provide support and education, and deal with life stressors in order to competently prescribe medications,” he continues. The way most psychiatrists deal with the low reimbursement for insurance patients in private practice is to limit the time of the med check visits to 15 to 20 minutes.

Some clinics also limit time for med checks, says Dr. Waxmonsky, because there are so many patients and so few doctors, especially in child psychiatry. “I chose to work for the university and collect a salary that’s not tightly wedded to the number of people I see per day—so I can spend more time per visit. I really think this extra time and attention is why most families say they like coming to the university clinic.”

Bipolar Disorder & Dealing With Relapse

There may not ever be a last episode, but there are ways to fend off and mitigate the next one.

Doctors never talked to Elly L. about relapse.

Although she was hospitalized during a manic episode and diagnosed with bipolar disorder, doctors never mentioned that it could happen again. Instead, Elly was stabilized, handed a prescription for mood stabilizers and discharged. She had no idea that she’d be battling mania and depression for the rest of her life.

“I was told that as long as I took my medications, I’d be okay,” recalls Elly, a mental health coach in Toronto, Ontario.

Elly experienced at least eight relapses between her diagnosis in 1978 and 1991. Each time, she was hospitalized, often placed in restraints and taken to the psychiatric ward in a police car or ambulance. Upon discharge, Elly always promised herself it would be her last hospital admission—but she had no idea how to stave off future relapses.

In bipolar disorder, relapse is defined as the return of depression or a manic or hypomanic episode after a period of wellness. According to a 1999 study published in the American Journal of Psychiatry, 73 percent of those diagnosed with bipolar disorder experienced at least one relapse over a five-year period; of those who relapsed, two-thirds had multiple relapses.

“You can never say that someone with bipolar disorder has had their last episode; relapse is part of the illness,” explains Alan C. Swann, MD, professor and vice chair for research in the Department of Psychiatry and Behavioral Sciences at The University of Texas Medical School at Houston and director of research for the University of Texas Harris County Psychiatric Center. “Relapse is self-perpetuating; once it happens, the more likely it is to happen again.”

Searching for answers

It’s possible to do all of the right things— follow a proper medication regimen, eat well, exercise, minimize stress and get enough sleep—and still experience relapse. Unfortunately, there is no clear understanding of why this happens.

“There may be changes in the cellular level that cause cycling but their cause is unknown,” says Joseph R. Calabrese, MD, director of the Mood Disorders Program at the Case Western Reserve University School of Medicine in Cleveland, Ohio.

While the neurological causes of relapse are unknown, a few things are certain: Those who are diagnosed with bipolar II are more likely to relapse than those with bipolar I. Their episodes of depression, mania or hypomania are often shorter than the episodes experienced by those with bipolar I but tend to return more often, according to Calabrese. It’s also far more common to relapse into depression than into mania or hypomania. Calabrese estimates that in bipolar II, there is a 40-to-1 ratio of depression to mania; the ratio of depression to mania drops to 3-to-1 in bipolar I.

I was told that as long as I took my medications, I’d be okay.- E.L.

“The key to recovery is a low tolerance for relapse,” says Calabrese.

In fact, Dr. Roger S. McIntyre, MD, associate professor of psychiatry and pharmacology at the University of Toronto and head of the Mood Disorders Psychopharmacology Unit at the University Health Network, believes that even the mildest symptoms of depression and mania should be treated as potentially hazardous.

“The takeaway message is that we need to seek complete elimination of symptoms as our treatment objective,” he says.

Health implications

Aside from the obvious impacts of relapse, which can range from an increased need for sleep and low mood during depression to racing thoughts, sexual promiscuity and hospitalization during mania, there is another reason it’s important to protect against relapse.

It was like getting on a roller-coaster ride; I was excited about it.- M.A.

“People who have had multiple relapses—somewhere in the range of 20 to 30 relapses over a few decades—tend to have worse brain scans,” notes Allan Young, MD, PhD, chair of the Department of Psychiatry and the director of the Institute of Mental Health at the University of British Columbia in Vancouver, Canada.

As a result of relapse, brain scans show a loss of brain volume and structure, a decrease in grey matter and tiny lesions in white matter, which may lead to impaired cognition and emotional regulation and, in extreme cases, fine level paralysis.

Relapse also contributes to metabolic syndrome, which includes symptoms such as high blood pressure, high cholesterol as well as an increased risk of heart disease, according to Calabrese. The more times relapse occurs, the more likely health problems are to develop.

“If you don’t worry about relapse, you’re allowing your illness to morph into increasingly longer and more severe periods of depression and mania and that’s where the morbidity, mortality and suffering occur,” says Calabrese.

Medication matters

For years after his 1997 diagnosis, Michael A. craved the high he felt during mania and often stopped taking his medication to trigger a relapse into a manic state.

“It was like getting on a roller-coaster ride; I was excited about it,” recalls the 40-year-old from Bronx, New York.

In 2002, after Michael intentionally relapsed into full-blown mania, he went on a spending spree and charged 15 video game consoles on his credit card. Hours later, the mania spiraled into depression and Michael was admitted to the hospital and placed on suicide watch. Over the course of eight years, he was hospitalized five times because he relapsed after discontinuing his medications.

“People who stop taking their meds have an 80 percent chance of relapsing within three months,” Young says. “Medication holds the illness in check; when you stop taking your medications, things go awry.”

Though medication remains one of the primary treatments for bipolar disorder, research has shown that regardless of the drug regimen, medication alone is not enough to prevent relapse.

Taking action

The best approach for preventing relapse is a combination of medication and the avoidance of activities that may trigger a new episode of illness.

It wasn’t until she started attending a support group through the National Alliance on Mental Illness (NAMI) that Adria A., 41, realized that she could have some control over bipolar disorder. Diagnosed in 2000, Adria relapsed twice before she was introduced to NAMI and encouraged to create a relapse prevention plan. Now, she keeps a poster-sized grid in her New York apartment to track her thoughts, feelings and actions in several areas of her life, including finances, family, employment and health, to identify possible triggers for relapse.

“Charting things helps me recognize patterns and keeps me from making poor choices,” says Adria. “When I feel like I’m experiencing a setback, I reach out to my support group or my therapist because I know I can’t let [my triggers] spiral into something I can’t handle.”

It’s been almost two years since Adria experienced her last relapse; she credits her relapse prevention plan with helping her take immediate action when faced with possible signs of relapse.

In 2007, a team of researchers at the Australia-based Mental Health Research Institute of Victoria found that participants with bipolar disorder who monitor their mood and recognize triggers and early warning signs of oncoming illness experienced half the number of relapses as the control group.

“If you can pick up on the early stages of relapse before it develops into a full-blown illness, you can decrease the length and severity of the episode,” says Swann. “Creating strategies aimed at heading episodes off early is so important.”

According to Swann, those with bipolar disorder often recognize a pattern of symptoms that precede relapse; the signs tend to be consistent for each person. For example, an increased need for sleep may signal a relapse into depression while irritability could be a sign of an oncoming manic or hypomanic episode.

Mindfulness-based cognitive therapy (MBCT) also appears to be an effective tool for combating relapse. A 2008 study published in the Journal of Affective Disorders found that MBCT, which uses cognitive therapy and meditation to help bipolar patients become more aware of their thoughts, helps reduce anxiety that may trigger relapse.

Elly started practicing yoga and meditation in the 1980s to help deal with racing thoughts. She still rolls out her yoga mat at least twice a day and believes it’s one of the reasons she hasn’t experienced a relapse since 1991.

I know I can’t let [my triggers] spiral into something I can’t handle. -A.A

“I started viewing bipolar disorder very holistically,” she says. “Yoga and meditation brought calmness and the deeper I got [into the practice], the more helpful it was at calming me down when I had racing thoughts or felt overwhelmed.”

A family affair

For Michael, who had eight relapses and several hospitalizations between 1997 and 2005, family was the key to managing his illness.

Michael acknowledges that his reckless behavior during mania had a profound impact on his life but it wasn’t until 2003, when he flew from New York to California without telling anyone of his plans, that he realized how his illness impacted his family and made the commitment to get well.

“My family was frantic and started thinking about calling the New York City morgue because they thought I might be dead,” Michael recalls. “I felt so bad when I heard that they lived in fear of my next relapse and I understood that being bipolar wasn’t just about me, it was about my family, too.”

As part of his commitment to preventing relapse, Michael attended therapy sessions with his parents. Over the course of five years, the therapist worked with the family to understand bipolar disorder and develop strategies to improve their communication skills and rebuild their relationship.

“I finally realized that what my family wants most is to prevent me from relapsing and going back into the hospital; they want me to be well,” says Michael. “It’s so nice to have people looking out for me because I don’t want to have another relapse and with their support, I know I have a better chance.”

According to a 2003 study in the Archives of General Psychiatry, 35 percent of those who participated in family therapy experienced relapse after two years, compared with relapse rates of 54 percent for those who received no family therapy. Moreover, a study in the British Journal of Psychiatry in 2010 found that family therapy reduced conflict, improved communication, increased empathy, leading to longer periods of wellness and less severe manic and depressive symptoms.

“Family members start recognizing that this is an illness, not something the patient is doing to make people angry or reflection of an ill temperament,” principal investigator David Miklowitz, PhD, wrote in the study. “When families start thinking of the behaviors associated with the disorder as biologically or genetically driven, they tend to be more tolerant.”

Attitude is everything

When 32-year-old Rachael B. was diagnosed with bipolar disorder in 2003, her doctor emphasized the risk of relapse. Determined to avoid additional episodes of depression and mania, Rachael began tracking her moods, identifying triggers and taking steps to stay well, including eating right, exercising and getting enough sleep. Over the next four years, she didn’t have a single relapse. She lapsed into countless periods of depression (and a few episodes of mania) again after her daughter was born in 2007.

“I knew when I decided to have a child that I was risking my mood stability,” says the Web consultant from Naples, Florida. “Sometimes, things are going really well one day and I wake up the next morning and I’m depressed. There are times that I’m nervous before bed because I never know what the next morning is going to bring.”

Though Rachael worries about the impact of her illness on her business and admits to feeling like a bad mother when she can’t get out of bed, she is convinced that she can regain control over her relapses. She tries to maintain a regular workout schedule, avoids processed foods and chemical additives, takes medication and sees a therapist on a regular basis. Over the past three years, she’s whittled the length of her depressive episodes from six weeks to two weeks and decreased their frequency, too.

“Being an active participant in my care makes me feel more hopeful about my path,” she says. “I was stable for years without any more ups or downs than someone who doesn’t have bipolar disorder. I know that it’s possible to get back there; it just might take some time. In the meantime, I have hope.”

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Coping with relapse

It’s possible to minimize the impact of relapse by implementing a few strategies.

Take your meds: Medication adherence can help prevent recurrent depressive and manic or hypomanic episodes. If relapse occurs, “your dose might need to be adjusted or a new medication might need to be added,” says Swann. Relapse isn’t an open invitation to stop taking meds.

Avoid triggers: Adequate sleep, physical activity and social contact are all important for preventing relapse, according to Young. “It’s important to develop strategies to protect these rhythms,” he says. “Maintaining them can help protect against relapse or minimize its severity.”

Know your risks: Just like bipolar disorder has a genetic component, the course of the illness runs in families, too. If others in the family have been diagnosed with bipolar disorder, take note of their relapse triggers and look for patterns with your own experiences, advises Swann.

Take immediate action: At the first signs of possible relapse, talk to a healthcare professional. “When symptoms of the illness start to come back and are very mild, it’s relatively easy to treat,” Calabrese says. “It’s harder when it drags on for weeks or months and takes on a life of its own.”

Ask the Doctor: My Bipolar Worsens as the Seasons Change

If your mood evolves with the seasons, we have some tips for you on how to successfully manage them.

Is this common? How does it work?

The changing of the seasons frequently affects bipolar disorder. Typically, depression is present in the fall and winter, and hypomania or mania kicks in during the spring or summer. Sometimes the seasonal impact seems to be reversed, with summer bringing depression and winter bringing hypomania or mania. The fact that you have noticed a pattern in your illness will help you manage.

Let’s look at seasonal changes from two perspectives: the effects of sunlight, and the changing activities that different seasons bring.

The daily amount and intensity of sunlight varies with the seasons and our location on the earth. With seasonal changes, the increase or decrease in light intensity and the lengthening or shortening of the days can affect bipolar disorder by disrupting the body’s circadian rhythms of wake and sleep.

Sleep and energy are especially important in bipolar disorder, of course. In depression, sleep may be either excessive or deprived, but energy is low. In hypomania or mania, fewer hours of sleep occur but energy is high. In healthy mood, the effects of sunlight and darkness set up a normal circadian rhythm and sleep and energy are well regulated by the brain.

There is a second factor in the relationship between the change of seasons and the symptoms of bipolar. Just as the seasons change from one to the next, so too are our activities affected by events that mark these seasons—the anticipation of fall, the frenzy of the holidays, the blahs afterward. In temperate climates, we may be more physically active in the spring and summer and tend to hole up in the winter; in warmer climates the pattern may be reversed.

Sometimes it’s difficult to tell whether it is our activities that are causing seasonal differences in our experience of bipolar disorder, or whether it’s a matter of how much light and darkness we are receiving. Becoming more aware of how these factors affect you can help you find ways to prevent, or at least mitigate, their effects.

In addition to treatment, what can I do to deal with seasonal changes?

You have already taken an important first step: recognizing the effects of the seasons on your illness. Certainly you will want to talk to your treating clinicians about what can be done withmedications to help you feel better. And if you haven’t talked to your prescriber about the use of light therapy to help regulate your circadian rhythms, be sure to have this conversation.

There are other things you can do, as well. Try sitting down with a yearly calendar and mapping out your activities. It’s best to use a calendar that has the whole year on one page. Mark out the times during the year that seem to cause you more difficulty, as well as those during which you typically feel better.

Next, ask yourself how advance planning might help you manage the difficult times. For instance, if you know you always feel depressed after the holidays, could you plan a special activity to look forward to? If the holidays are too hectic, can you think of ways you can simplify things next year? If summer is hard, perhaps you can ramp up your talk therapy beginning in the spring.

In addition, discuss season changes with your support group. Find out how others are dealing with similar challenges —some of their techniques will work for you.

Dealing with seasonal changes requires that you develop a long-term overview of your illness, its patterns, and its effects. Take a good look at your patterns several times a year, checking your old calendar to see how accurate you were in predicting seasonal effects. Make a note of any activity changes you implemented that were effective so you can build on them in future years.

You are doing well to notice the effect of the changing seasons on your illness. Paying attention to circadian rhythms and your seasonal activities can be a key skill as you manage your wellness.

How my Psychiatrist Impacted my Bipolar Journey

As I left my psychiatrist appointment today, I truly recognized how integral Dr. Song has become to my wellness in managing bipolar disorder. We first met when I was admitted to the Eric Martin Pavilion subsequent to my first and only suicide attempt that landed me in the intensive care unit at the hospital for 3 days. I was only twenty-five years old and as I sat agitated in my pale hospital pajamas, I stared at the floor as my brain buzzed with the aftermath of a severe medication overdose. Dr. Song carefully approached me and simply asked in a gentle voice, “Are you okay?” Upon first meeting him, I recall looking up to see a face that appeared genuinely concerned for my well-being, which is not something I had experienced in a long while. He reached out his hand, introduced himself in a professional manner and his presence felt instantly comforting. There was something unique about this doctor as I recognized that he quickly demonstrated a great deal of respect for me.

A Psychiatrist Inspiring Hope

As we spent time in appointments together during my hospital stay, he advised that he planned to administer a new medication regime. I resisted with angst as I expressed that my experience with medication was nothing short of horrendous.

He then asked me, “Is what you’re doing working for you?” I felt my brain rewind to my initial breakdown and how I nearly perished due to my inability to manage my bipolar disorder.

Due to our initial interactions, I quickly felt compelled to trust him and I soon accepted that he was indeed the expert. Over the course of one month, he inspired me to complete small tasks such as taking a shower and I soon adhered to a new medication plan. He constantly highlighted my personal life triumphs and reminded me that I was a bright and capable individual who has a university education and a meaningful employment background. Over time, he truly revealed that he believed in me.

Encouragement Ignites Success in Bipolar Disorder

As years passed, Dr. Song witnessed my most desperate moments, such as my spiral into addiction, a temporary leave from my place of employment and my ongoing struggle with psychosis; however, he always listened intently to my every dream and plan in life. He never attributed my grandiose thinking to my mental illness, but instead, he showed his support with encouragement. I dreamt of creating a charity for people living with bipolar disorder and over the years he applauded my branding ideas for my Bipolar Babe Project. As the Project moved forward, he attended a number of my fundraising events and once I did register the Bipolar Disorder Society of British Columbia, he joined the Advisory Council and acts as a valuable member of our team to this day. I have always attributed much of my success and stability to Dr. Song, but today it felt so much more profound. He is an integral part of my mental health security net and if I were to ever fall, I know that I would certainly be caught.

Subsequent to my appointment with Dr. Song, I exited the building and sat on the park bench in front of the psychiatric facility. Instead of looking upon the mental health institution with distaste and regret, I felt a wave of gratitude flow deeply throughout my being. Yes, this building represented my mental imprisonment in my most dire moments, but it was there that I met Dr. Song and where I truly began to accept and manage my bipolar disorder. For this, I am truly grateful.

10 Ways to Shake Up Date Night

comedy-club
Do something different
After being in a relationship for years (months, for some couples), climbing out of a dating rut can be difficult. That’s why we’re making it easy. Grab your significant other and get ready for a good—but different—time. Here are our 10 ways to shake up your date night.

Laugh it up
Crack up at a comedy club with your sweetie.

Get cooking
Take a cooking class (bonus points for learning a foreign cuisine).

RELATED: 15 Everyday Habits to Boost Your Libido

joy-ride-date

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Take a joy-ride

Rent a fun car—a Prius, a Volkswagen Beetle, a Smart Car, a Mustang—and go for a mini–road trip.

Nighttime adventure
Get a glow-in-the-dark Frisbee and head to the park.

RELATED: 6 Trips That Make Couples Closer

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dance-lessons

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Partner up

Hit the dance floor with salsa or two-step lessons.

Wish upon a star
Visit your local astronomy club’s open-telescope night and go stargazing.

new-music

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Be a spectator

Watch a new sport; try a monster-truck exhibition or a model-airplane race.

Mix up your music
Try new music. Symphony fans, visit a bluegrass club; rock-and-rollers, give chamber music a try.

back-yard-camping

4 Summer Food Safety Tips

Preventing Foodborne Illness

Picnics, backyard barbecues, beach cookouts—dining al fresco is one of summer’s best perks. But it’s easy to forget that as the temperature rises, so does your chance of getting sick from contaminated food. Bacteria thrive in warmer conditions and people are cooking outdoors frequently—away from sinks, refrigerators, and kitchen thermometers.

What can you do to avoid the unpleasant experience of food poisoning this summer?

2 of 5 Jean-Blaise Hall/Getty Images
Stay Clean

Washing hands, surfaces, and food is one of the easiest ways to prevent foodborne illnesses. “In some cases people know about the basics but they don’t always do them, and obviously these practices are well worth the time,” says Shelley Feist, executive director of the Partnership for Food Safety Education.

Always wash hands with soap and water for at least 20 seconds before and after handling food. If you are outdoors without access to a sink, use antibacterial hand sanitizer as an alternative.

Rinsing fruits and vegetables is as simple as running tap water over them, but without access to running water it can be difficult. Washing your food before packing it in your picnic basket will ensure that the food is clean–even if your camp site doesn’t have fresh water.

3 of 5 Foodcollection/Getty Images
Separate Raw Food

During grilling season it can be more difficult to avoid cross-contamination because there’s often less access to clean surfaces and dishes. “When raw meat goes on the grill you can’t put it back on the same platter you brought it out on,” says Feist. Have an extra plate on hand or thoroughly wash any utensil, dish, or surface that has touched raw meat or seafood with hot, soapy water before reusing.

Cross-contamination can also occur when traveling if raw meat, seafood, and poultry aren’t wrapped properly. Carefully wrap food and place it in a separate cooler (or at the bottom of the cooler) to prevent any raw juices from leaking and contaminating other foods.

4 of 5 Radius Images/Getty Images
Cook Food Thoroughly

Don’t depend on the color of meat or seafood to determine whether or not it’s cooked thoroughly. “Consumers are stubbornly stuck on visual indicators but, for both quality and safety, using a thermometer gives you an idea that it’s safe and not overcooked,” says Feist.

Instead of cutting your meat, poultry, or seafood open (and dirtying more utensils!), determine its readiness with a food thermometer and the USDA’s food temperature guidelines.

5 of 5 C Squared Studios/Getty Images
Keep Cold Food Cold

Traditional picnic baskets may look pretty, but they won’t keep your food at a safe temperature for long. And since it’s necessary to discard any food that has been left out in the summer sun for more than two hours (one hour if the temperature exceeds 90 degrees), choose a well-insulated cooler filled with ice instead.

Though a cooler is never an ideal replacement for a refrigerator because a home refrigerator should be kept at 40 degrees or below, there are four easy ways to slow down the growth of harmful bacteria:

Keep coolers out of direct sunlight and use separate food and beverage containers to help maintain a lower temperature. On a hot summer day, you should be drinking plenty of water so the beverage cooler will likely be opened (and thus exposed to warmer temperatures) more frequently.
Nestle bowls of summer salads in larger bowls of ice to direct cooling and insulate food.
Full coolers tend to stay cold longer. If your cooler has empty space, fill it with ice.
If traveling by car, don’t store your cooler in the trunk—the temperature is typically lower in the passenger area.

Scientists are naming new species after musicians, and it’s kind of amazing

SERICOMYRMEX RADIOHEADI

Sericomyrmex radioheadi is a new species of “silky” ant that grows fungus gardens for food.

Ana Ješovnik

No one really knows how many species actually inhabit planet Earth—some say millions, others trillions—but regardless, it’s the job of taxonomists to name them all. Seriously, what the heck would you call an elephant—let alone these horrifying species living in the depths of the sea—if there were no system in place for naming them?

And now, a brief history lesson (it’ll be brief, promise!). Since the era of the Greek and Roman empires, taxonomists have tried (as best they can) to make sense of the world around them. Enter Swedish botanist Carl Linnaeus, who burst onto the scene in 1757, with his namesake hierarchy system. Finally, there was order. Over the centuries, the Linnaeus hierarchy has evolved, but for the most part, things have remained constant for scientists identifying new species.

BEIBEILONG SINENSIS

A new species of bird-like dinosaur called Beibeilong sinensis.

Illustration by Zhao Chuang

Once a scientist has identified a new species, they’re bound by the rules (known as nomenclature) of the Linnaeus hierarchy when it comes time to give that species a name. The two most important guidelines are:

Each species must be classified according to the Linnaeus’ hierarchy (duh!)
New species’ names must be derived from Greek or Latin
While vague, this rule presents some interesting challenges (and creative opportunities) for taxonomists. Take the giant, feathered dinosaur above—known as Beibeilong sinensis—which translated means baby dragon from China. Because Chinese is not based on a Latin alphabet (and has zero Latin roots), Chinese scientists are often more deliberately creative when naming new species. And more recently, there’s been a trend towards naming species after musicians old and new, and it’s kind of amazing! For your viewing pleasure, here are a few of the rarest new species named after musicians.

Sericomyrmex radioheadi is a new species of “silky” ant that grows fungus gardens for food.

Ana Ješovnik

Two scientists from the Smithsonian’s National Museum of Natural History named a new species of ant in the genus Sericomyrmex after the famous British band Radiohead in honor of the group’s music, as well as its environmental efforts. Ants of the genus Sericomyrmex – literally translated as “silky ants” – belong to the “fungus-farming ants,” a group of insects that have figured out how to farm their own food. This is particularly fascinating, considering ants perfected farming nearly 30 million years ago.

SCAPTIA (PLINTHINA) BEYONCEAE

Scaptia (Plinthina) beyonceae is the “all-time diva of flies.”

Wikimedia Commons / CC BY-SA 3.0

First collected in Queensland, Australia in 1981—the year of our Queen Beyoncé—Scaptia (Plinthina) beyonceae was once considered a common pest, but was named after the famous singer in recognition of the unusual gold patch on its abdomen. According to Bryan Lessard, from Australia’s science agency CSIRO, “It was the unique dense golden hairs on the fly’s abdomen that led me to name this fly in honor of the performer Beyoncé as well as giving me the chance to demonstrate the fun side of taxonomy – the naming of species.”

SYNALPHEUS PINKFLOYDI

Synalpheus pinkfloydi is a newly discovered species of shrimp that kills with sound.

Arthur Anker

In April 2017, scientists Sammy De Grave, of the Oxford University Museum of Natural History in England, Arthur Anker of the Universidade Federal de Goiás in Brazil, and Kristin Hultgren of Washington’s Seattle University, deemed a new species of pistol shrimp as Synalpheus pinkfloydi. Pistol shrimps (aka snapping shrimps) generate substantial amounts of sonic energy by closing their enlarged claws at rapid speeds to create a high-pressure bubble. The resulting bubble implosion is one of the loudest sounds in the ocean, strong enough to stun a small fish—just like standing too close to an amp at a rock concert. “I have been listening to Floyd since The Wall was released in 1979, when I was 14 years old … The description of this new species of pistol shrimp was the perfect opportunity to finally give a nod to my favorite band,” said Oxford’s Sammy De Grave.

GAGA GERMANOTTA

Forget a new species, an entire genus of ferns (found in Central and South America, Mexico, Arizona and Texas) have been named after Lady Gaga.

Curtis Clark / Wikimedia Commons CC BY-SA 3.0

Naming a new species after your favorite musician is cool, but what happens when you stumble upon a group of ferns that bear a striking resemblance to Lady Gaga’s outlandish costumes? For Kathleen Pryer—a Duke University biology professor and director of the Duke Herbarium—”the ferns themselves gave us more reasons why it was a good choice,” she said. And when two new species of ferns—Gaga germanotta(named to honor the family of the artist) and Gaga monstraparva (named in honor of Gaga’s fans)—were being considered for a genus containing 17 similar fern species, Pryor’s trained eyes noticed how uncannily similar the bisexual reproductive stage of the ferns looked to the heart-shaped Armani Prive costume that Gaga wore to the 2010 Grammy Awards. In speaking with Duke Today, Pryer also noted that the way the fern extends its new leaves in a clenched little ball looked eerily like Gaga’s claw-like “paws up” salute to her fans. The deciding factor to name the whole genus after Gaga presented itself when Duke graduate student Fay-Wei Li scanned the DNA of the ferns being considered for the new genus, and found GAGA spelled out in the DNA base pairs as a signature that distinguishes this group of ferns from all others. Clearly they were fern this way!

ALEIODES SHAKIRAE

Those hips don’t lie! Aleiodes shakirae, a new species of Ecuadorian wasp, causes its host caterpillar to shake and wiggle using moves that put Shakira to shame.

Eduardo Mitio Shimbori, Scott Richard Shaw / Wikimedia Commons CC BY-SA 4.0

Aleiodes are very small wasps—only 4 to 9 millimeters in length—and they belong to a particularly rare subfamily of wasps that mummify the caterpillars on which they parasitize. Ready for the gory details? The adult female wasps inject an egg into a particular type of caterpillar. Once the egg hatches, the host caterpillar remains alive for a time while the wasp larva slowly eats its insides. Eventually, the caterpillar shrinks and dies, and the larva forms a cocoon inside the husk. But one key observation—made by Dr. Eduardo Shimbori and Dr. Scott Shaw—sets Aleiodes shakirae apart from the 23 other species in this subfamily of wasps: when the two scientists first encountered the Ecuadorian species, they noticed the host caterpillar shaking and wiggling as the wasp larva slowly ate its insides. The scientists were instantly reminded of Shakira’s dance moves.

HETEROPODA DAVIDBOWIE

Say hello to Heteropoda davidbowie, the spider from Mars! If you look closely enough, its face looks similar to the painted face from David Bowie’s early career.

Seshadri.K.S / Wikimedia Commons CC BY-SA 4.0

First described by Peter Jäger in 2008—based on a specimen collected by G. Ackermann in 2007 in the Cameron Highlands of peninsular Malaysia—Heteropoda davidbowie is a species of huntsman spider from the genus Heteropoda. Unlike the female members of the species, male “David Bowie spiders” have a reddish brown dorsum, and contain distinct brightly colored hairs, which form patches and lines. When viewed up close, the spider’s face is said to resemble the painted face from David Bowie’s early career.

The 19-year-old helping to stamp out homophobia at music festivals

If you were at V Festival or Reading and Leeds this year, you may have noticed some LGBT videos playing in between sets.

It’s all down to one 19-year-old who was fed up that he, and lots of people he knew, were experiencing homophobia.

So Dave Olshanetsky wrote to Melvin Benn, the boss of Festival Republic, who runs festivals worldwide.

To his surprise, he wrote back and now they are working together to stamp out homophobia at music events.

“I’d gone to a festival before with a guy, and these girls were just pushing us,” Dave recalls.

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“At first I thought they were just trying to get to the front and then we saw their main issue was just with us.

“It only happened after they saw us kiss and they had a bottle of wine and they tried to pour it all over us.”

He says he complained to the security guards but they said there was nothing they could do because there was nothing in their rules about homophobia.

Dave has a big following on his Tumblr account and says people were messaging him with similar stories.

“So I found Melvin Benn’s email and wrote to him,” he tells us backstage at Reading Festival.

“I said, ‘I’ve experienced some of this stuff personally and here are the statistics from other festivals showing this is a widespread issue and nothing is being done about it.'”

He says Melvin Benn responded and asked to meet him so they could figure out how to tackle the issue.

“Firstly, we decided that all security staff needed to know various homophobic slurs and slang,” he explains.

“They should treat them the same as if they heard a racist term and if they hear it, they’ll cut the person’s wristband off and they will be thrown out.

“There are also videos we have helped to create that are played at every festival from Wireless to Download, V to Reading and Leeds.

“They show that festival culture and diversity is really important and if you are someone who wants to tell two guys kissing to stop then this is not the place for you and it won’t be tolerated.”

These plans were only decided in May just as the festival season was beginning.

The videos are played at all the festivals run by Melvin Benn and Dave says the festival boss has been speaking to other festival organisers too.

He also says there are more plans that could be implemented next year.

These include an LGBTQ hour at the silent discos plus more LGBTQ representation at festivals