Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: You’re listening to Inside Bipolar, a Healthline Media Podcast, where we tackle bipolar disorder using real-world examples and the latest research.
Gabe: Hey everybody, welcome to the podcast. My name is Gabe Howard and I live with bipolar disorder.
Dr. Nicole: And I’m Dr. Nicole Washington, a board-certified psychiatrist.
Gabe: And today we are going to answer the top ten most asked questions about bipolar disorder, according to an online poll. And I wouldn’t have thought that most of these would be the ten. Dr. Nicole, you’ve seen the list of ten questions, were there any in there that surprised you, or were they all just pretty basic?
Dr. Nicole: I think they’re pretty basic things that I could see someone who’s who’s trying to figure this bipolar thing out. I could see these being questions that are being googled. Yeah.
Gabe: You can? Okay. Well, good. Well, let’s go ahead and just rip the Band-Aid off and start with the very first question. And I think it’s a good
Gabe: These are in no particular order.
Gabe: But the very first one that I do think that we should start off with is what is bipolar disorder?
Dr. Nicole: Well, let’s just jump right on in. Bipolar disorder is a mood disorder. It has two distinct episodes if you have bipolar I, depression episodes, and mania if you have bipolar II, depression episodes and hypomania depression. I think we all know what depression looks like. There’s no question about that. Normally the mania and the hypomania are going to be a heightened mood state and elevated mood state, which is either euphoric or severe agitation. And then there’s other symptoms that go along with those depending on the severity determines whether you fall into the mania or hypomania bucket. But it’s a heightened mood state with increased energy, and that heightened mood state is either euphoric or severely agitated.
Gabe: I always like to use the example of bipolar disorder as highs and lows. But you exist on this spectrum, so? So the lowest is suicidal depression and the highest is full blown mania. For bipolar II, the highest is hypomania. And then you’re moving back and forth on that spectrum. Now there’s there’s other hallmarks you can have like hypersexuality, anxiety, grandiosity. You touched on like agitation and euphoria, which is common in mania and things like that. But all in all, it just it’s like mood swings on steroids that the person has a lot of trouble controlling. And you’re back and forth on this pendulum. But one of the things that I always like to point out on the pendulum, to make sure that people really understand it, is that normal, stereotypical. Average safe mood. States are part of bipolar disorder mood swings. It’s not just one or the other. Sometimes people think that you either have to be depressed or you have to be excited. And if you’re ever in the middle, it’s not bipolar disorder because after all, you can control it. And I think that’s a common misconception.
Dr. Nicole: I actually hate to use the word mood swing when it comes to bipolar disorder. I prefer mood shifts because I think a shift is more in line with what we see. I mean, you talk about this spectrum where you move along the spectrum from one episode to normal to the other episode, but it’s not always a swing. It’s not always a very quick movement. It’s more of a shift. So you are not just running up and down this spectrum, and one minute you’re manic and the next minute you’re depressed and maybe you feel good and then you’re depressed again. It’s not that quick because when we start talking about rapid cycling bipolar disorder, we consider rapid cycling to be somebody who has four or more of any mood episode in a year, in a year. But the way we sometimes describe bipolar disorder, we describe it as if a person is just rapidly shifting and swinging between these episodes, and that’s not necessarily what it is. So I do think it’s important to be very intentional about how we describe these mood swings, which is why I prefer shift.
Gabe: At first blush, I thought this was a kind of a stupid question. I mean, if you’re listening to a podcast called the Inside Bipolar Podcast, why do you want to know what bipolar is? Don’t you already have it? But I got to tell you, as you and I have been discussing it and and really reflecting on my own life, living with bipolar disorder and the work I do in the bipolar community, both leading support groups and attending support groups. There really is a lot of confusion about exactly what bipolar disorder is, what the diagnosis means, what recovery looks like, what the treatment is. So this is not the simple question that it seems to be. I want to continue along this same vein, because there’s sort of a follow up question to this one. It is one of the ten. What are the different types of bipolar disorder.
Dr. Nicole: Yeah, that that is a good one because when you when we talk about it, most of the time we don’t distinguish between the different types. We just say, oh, that person has bipolar disorder. So I do think it’s important for us to go through that a little bit. So you have bipolar 1, bipolar 1, major depressive episodes, manic episodes, bipolar II hypomanic episodes,
Dr. Nicole: And major depressive episodes. Mania and hypomania are differentiated based on the length of time, severity of symptoms. But but both in that elevated mood. State range Cyclothymia is in the DSM in the chapter with bipolar and related disorders. Cyclothymia is a bipolar like illness, and we do lump them together where a person has depression symptoms that don’t quite meet criteria for a full major depressive episode, and they also have hypomanic symptoms that don’t quite meet criteria for a full hypomanic episode. So those are the main three. But then we also have to consider people can have a bipolar episode or bipolar disorder secondary to substance use. So a person can use drugs, whether they be prescription drugs or whether they be illicit drugs that can cause manic like symptoms. So we have to be aware of those kinds of things, and then we have to be aware of medical conditions that can sometimes mimic a bipolar presentation.
Gabe: This next question. I’m kind of sad that it’s on the list. I wish that people just automatically knew the answer to this question and didn’t need to ask it because it was so obvious. And that question, Dr. Nicole is can bipolar disorder be managed effectively?
Dr. Nicole: Absolutely. Absolutely 100%. Yes yes yes yes yes. It can be managed effectively. People can go on to live whatever lives they thought they were going to live. It doesn’t have to prevent you from fulfilling all the dreams and goals you had for yourself. It doesn’t have to do those things.
Gabe: As a person living with bipolar disorder. Yes, yes, yes, it can absolutely be managed effectively. I really like to put myself out as an example of that. I like to model the way I. I like to show people that at the end of the day, I’m a boring middle-aged man who lives in the suburbs. I’m married, I have a dog, I own a house, I have a job, I have friends, I get bored like everybody else. I get mad at my mom. I mean, I’m doing stereotypical normal suburban white guy stuff. It’s it’s exciting sometimes and it’s mundane most of the time. And that’s really the hallmark of, of a stable, well-managed bipolar disorder. It’s not to say that it never rears its ugly head, because it does. And I do want to touch on that for a moment, because a lot of people believe that effective management of bipolar disorder means zero symptoms, zero relapse or zero struggle. And I think that definition leaves people wanting, frankly, because it’s not true. Dr. Nicole again, from a medical perspective, to throw it back at you as a psychiatrist, if somebody is showing any sort of symptom of bipolar disorder, do you consider them to be not managing effectively?
Dr. Nicole: Absolutely not. It. It comes with a territory. I don’t have very many patients who have bipolar disorder who don’t tell me, you know, I mean, I’ve been really great 98% of the time, but I’ve had a couple of days where my mood was a little low. I felt a little blah. It was a little bit more difficult for me to pull myself out of bed. That day. I noticed that I didn’t really want to do anything. I wasn’t making small talk. Sometimes people have little off days they describe to me, but I don’t think that means that they aren’t managing their illness effectively. I would actually say managing your illness effectively also looks like you having a plan to deal with those things when they come, and being able to move through them without letting them take you down, as maybe they have during previous episodes.
Gabe: Well. And isn’t that the hallmark of good management? Let’s look at business. Management doesn’t mean that you never have to discipline an employee, or reprimand an employee, or even fire an employee.
Gabe: Management just means that you are managing the situations as they arise, and
Gabe: High end leaders and very effective leaders manage those things well. But I think you’d be hard pressed to find any manager supervisor, boss leader who doesn’t have a story of when everything hit the fan. We
Gabe: All have those stories we tell them at conferences.
Dr. Nicole: We absolutely do. The whole plan is to have a plan in place that prevents as many hiccups as possible, but that also can intervene when the hiccups happen to prevent them from becoming really big hiccups.
Gabe: Hear, hear. I love that really big hiccups. s we keep moving along. This next one is not a surprise to me on the top ten. It’s actually a very complicated question and I’m really curious as to the answer. And I don’t know what it is. So I’m going to have to put just an awful lot of pressure on you, Dr. Nicole, because the very specific question is what causes bipolar disorder?
Dr. Nicole: Yeah, well guess what? You’re not going to put a ton of pressure on me, because the honest to God truth is, we still don’t know with 100% certainty. So we’re all in this boat of trying to figure out. We do that it could be a combination of things. We know that genetics play a role. We know that if you have a parent who has bipolar disorder. You have a twin who has bipolar disorder, a sibling. You have an increased risk of developing bipolar disorder. We know there’s a genetic component. We know that there may be biological aspects of you that would predispose you to having bipolar disorder. Those are things we’re still teasing out. Is there something different about the brain of a person who has bipolar disorder versus the brain structure of a person who doesn’t? Those are things that are constantly being researched and looked into. And then we also know that environmentally there are things and whether that’s environmentally in the womb that you were exposed to when everything was cooking and developing, that could be something that is a cause of bipolar disorder.
Gabe: I was really hoping you had a better answer, Dr. Nicole. I got to tell you, I was really hoping that science could figure this out for me. Because as a as a guy who lives with bipolar disorder, it’s terrifying. It’s just terrifying to not know how this happened, but there’s a lot of illnesses that we don’t fully understand where they came from or how it happened. There’s a lot of illnesses that we have less knowledge of than bipolar disorder. This is why we have medical science. Hopefully research will continue and hopefully someday we’ll will unlock this. But I did want to ask one sort of follow up question to this. That is not part of the ten. Is there any mental illness, not just bipolar disorder, but is there any mental illness or mental health issue that science has determined a cause for?
Dr. Nicole: I feel like we’re in the same boat for, for pretty much most mental illnesses that we are identifying. We do know that there’s probably a variety of things that could contribute to them. And those things continue to be genetically, biologically, environmentally. One of the things that I know a lot of family members look this up. A lot of family members are looking up what causes bipolar disorder. One of the things that I hear the most from the loved ones, and especially parents, because I think parents feel a great sense of guilt when their kid is diagnosed with bipolar disorder because their immediate thought is, what did I do wrong? What did I do? Was it my genes? You know, everybody starts digging and thinking like, okay, who in the family did it come from my side? Did it come from your side? Where did it come from? And then you read the information about environmentally, and people talk about the womb and things that could have happened in the womb. And the moms are thinking, oh my gosh, did I do something in my pregnancy that did this to my kid? There’s a lot of guilt that comes from parents when their kids are diagnosed with bipolar disorder. So I believe for 100% that this was a top ten because I know a lot of family members, namely parents, are the ones who are really, really looking for what in the world caused this? Because there is a lot of guilt and shame and just frustration with yourself when you’re a kid is diagnosed with bipolar disorder.
Gabe: While we can’t answer the question of what causes bipolar disorder, I do want to let people with bipolar disorder know, it most likely was nothing that your parents did. It’s been researched. You know, things like smoking while pregnant. Drinking while pregnant. While, these are not good things to do. There isn’t any conclusive research to show that this unequivocally leads to bipolar disorder. The reality is, is there’s been lots of troubled pregnancies. There’s been lots of pregnancies that have been marred by drug use, cigarette smoking, alcoholism, poor eating, exercise, lack of prenatal care. And the baby does not have bipolar disorder. Here’s the reality. It’s all come down to, we don’t know. It’s bad luck. All right, Dr. Nicole, are you ready to jump into the next question?
Gabe: All right. What are the symptoms of bipolar disorder? Can you name them all.
Dr. Nicole: Is this. Is this a test?
Dr. Nicole: Is this a test?
Gabe: I can say, you know, I got to say we can’t name them all the DSM. The section in there is probably huge. We don’t have time to go into them. So this is the one question that we should probably, maybe alter a little and say, what are the primary
Gabe: Symptoms of bipolar disorder? What are some things that people should be looking out for?
Dr. Nicole: Yeah. I mean, interestingly enough, when we’re in medical school, sometimes we use what are called mnemonics. And basically it’s like a, it’s an abbreviation for a first letter of several of the symptoms. And so for depression, you know, when you’re teaching medical students we teach them SIGECAPS when we’re teaching them depression symptoms. So it’s sleep interest guilt energy concentration appetite psychomotor changes and suicidal thoughts. Bam. There you go. Any of those things in a two-week period more often than not. And and you look at that as criteria possible symptoms of depression for mania. We are looking at several days. And I think the key thing to focus in on is the several days, not the I can be really great one day and then somebody say something to upset me. And then I’m very angry for three hours. And I’m meaner than a junkyard dog. And then I go back to being okay. That’s not the same. We’re talking about several days of an episode where you’re easily distracted, talking more, talking faster, not requiring as much sleep, impulsive increase in risky behavior without any regard to the consequences. Just increase in activity in general. Those are some of the main symptoms of mania. Hypomania.
Gabe: So to be clear, it sounds like the primary things that you’re looking for are that depression and that hypomania slash mania. And
Gabe: That’ll get you a diagnosis of bipolar disorder.
Dr. Nicole: And I’m looking for an episode that is different than who you are in your normal state. If you’re somebody who’s risky in general and impulsive all the time, and you spend a lot all the time and you have a gambling issue all the time, that’s not going to count into your mania or hypomania. But if you’re someone who that isn’t your typical behavior, and then you have these distinct periods where you’re doing all those things we talked about and having that behavior, I’m looking at it being a distinct episode.
Gabe: And then of course, there’s also symptoms like grandiosity, you know, thinking that, you know, more than everybody else hypersexuality, not being able to control your sex drive. There’s an anxiety and an addiction component that can factor in as well. These are all symptoms that somebody with bipolar disorder could have. Now there’s also psychosis. You can also have psychosis with bipolar disorder. Now it doesn’t mean that you have all of them in order to have bipolar disorder. But those are some common symptoms of bipolar disorder that a lot of people report. Did I get that right? I’m
Gabe: Trying to play doctor, Dr. Nicole.
Dr. Nicole: Yes yes yes. You hang out with me enough. And here you are. You’re you’re a psychiatrist by proxy. [Laughter]
Gabe: I’m a psychiatrist by proxy, I love it. That’s going to end up on my business card. This next question is another one that I am not surprised by. And we actually did a whole episode on this, so we’re really doing the CliffsNotes, Reader’s Digest, TikTok version for this next question, but I also want to let everybody know that how bipolar is diagnosed got itself a 40-minute episode. I recommend that you look it up to get way more information that we’re going to provide now. But Dr. Nicole for our top ten, how is bipolar diagnosed came up?
Dr. Nicole: Yeah. I mean, the CliffsNotes version is a whole lot of talking. That’s the that’s the too long, don’t read version. A whole lot of talking. A lot of questions, a lot of assessment. Your mental health professional that you’re seeing is going to ask you a lot of questions, because that’s how we tease out these symptoms that we’ve talked about. That’s how we tease out time frames, and that’s how we rule out other things. You may have lab work done to rule out some more medical things based on how you answer questions. We may look at substance abuse history. They’re going to feel very intrusive, but really it’s a lot of assessment and a lot of questions.
Gabe: In the how was bipolar diagnosed episode we delve into what those questions are, but I do have another question that I want to include here. Is there a definitive test for bipolar disorder? A urine sample, a blood test? A any sort of culture? Is there is there anything like that, a brain scan maybe.
Dr. Nicole: We’re not there yet. We are not there yet. I am hopeful that before I retire, maybe we will have some definitive answer as to this is a marker we can look for that will definitely tell us one way or the other, but we’re just not there yet. So? So there’s no definitive test as of yet.
Gabe: Along those same lines, I am hearing a lot about genetic testing for bipolar disorder medications, like where they do a swab and then that helps a psychiatrist determine treatment for bipolar disorder. Is that science evolved? Is that science there or is it just still in its infancy?
Dr. Nicole: You know, genetic tests for medications is tricky. I think people see them as, oh, I’m going to go get this swab done, and then the doctor is going to be able to know which medicine will work for me, and that’s not really the purpose of them. They can give us a lot of answers about how your body metabolizes certain categories of medication to tell us, should we prescribe higher doses or maybe you metabolize a certain thing slow. So we need to go low and go very slow with going up, because you’re more sensitive to that. They can tell us those kinds of things, but those answers don’t equate to what drug is going to work for me. And that’s where I think people get a little confused and frustrated because they think I’m going to get this swab, and then they’re going to give me the right medicine at the gate. And it’s just not always the case.
Gabe: Here’s another question that doesn’t surprise me that it’s on here at all. The specific question is what treatments are available for someone who has been diagnosed with bipolar disorder? I know we can’t name them all, but what are the what are the heavy hitters? What are the main ones?
Dr. Nicole: In general mood stabilizers. So we have our more traditional mood stabilizers like your lithium and valproic acids and carbamazepine in the mix. Several of the bipolar medications are also seizure medications. So if you’re out there googling and doing searches, you might see that. So don’t be alarmed. That is accurate. We do use several seizure medications for bipolar disorder. Some of them are in the category of antipsychotics, but we use them as mood stabilizing medications. So you might see medications that are also FDA approved for schizophrenia also being FDA approved for bipolar disorder. Some medications are the general treatment, but therapy can also be a very, very valuable intervention for somebody who has bipolar disorder, especially in those early phases of helping them come to acceptance of this diagnosis and what that means for them, and then later in helping them manage some of the depression symptoms, helping them, you know, come up with the plans to try to prevent episodes, help them with some behavioral things. That therapy can be very helpful as well.
Gabe: So it really sounds like a combination of medication and therapy as the front-line treatment for bipolar disorder.
Dr. Nicole: Yeah, absolutely. It it’s a combination of things. I think if you only focus on one of those areas, you really won’t see true recovery or true stability.
Gabe: I’m a real big proponent of that. And often when we talk about living our best lives, I really remind people that you need a combination of not only medication and therapy, but you also need good, good friend support, family and friends, whoever you choose your family to be. Peer support is also very valuable. Support groups as far as one on one or in a group setting. Very very powerful. Also things like routines, our own coping mechanisms. Designing our lives. Things like paying attention to sleep are all very important.
Dr. Nicole: Yeah, I agree with that 100%.
Gabe: And we’re back answering the top ten questions listeners had about bipolar disorder.
Dr. Nicole: Well, now, Gabe, I’m going to turn it over to you because one of the questions was, how does bipolar affect daily life? And I just felt like you probably should be the one to answer that question.
Gabe: Bipolar disorder impacts everything that you do. And living with bipolar disorder, I often find myself trying to figure out. Is this my feeling? Is this a feeling clouded by bipolar disorder? Where does my personality end and bipolar disorder begin? What is part of my illness and what is part of Gabe? And the answer is, is it’s kind of like peanut butter and jelly. I mean, it’s it’s talked about as two separate things. But the reason that we love peanut butter and jelly is because it mixes. It blends. Now, we don’t love the fact that bipolar disorder is blending with our personality, but I, I think it’s unrealistic to expect it not to. So the truth does lie somewhere in the middle when I’m trying to figure out what are my own wants and desires and wants and desires are colored by bipolar disorder, I would say that everything that I do is affected by bipolar disorder. The answer becomes how much and what level of awareness and understanding do I have?
Dr. Nicole: So help us understand how having that knowledge helped you deal with your bipolar disorder in your everyday life.
Gabe: Yeah. So let’s take Gabe before diagnosis. I experienced very severe depression and I didn’t know why I experienced that depression. I had all of these horrible thoughts. I felt all of these horrible things, and I believed they were true. I believed that my mother would be happy if I were gone. I believed that I would be better off dead. I believed what the depression was telling me, and I had no reason not to trust it. Now let’s look at a depressive episode after diagnosis, after therapy, after medication management, after learning coping skills, I still have those same feelings. I don’t want anybody to hear that in a relapse, those feelings don’t come back because unfortunately they do. But here’s where that understanding and knowledge comes in. I think to myself, I know that I feel this is true, but intellectually I know that it’s not. I know that I feel this, but I also know intellectually that it’s not. And here is my plan. Here’s what I can do. Here are the people I’m going to talk to. Here’s the person I’m going to call. Here are the action steps that I’m going to take. And here’s another really important piece. Depression really engulfed me. I mean, it was able to permeate every single area because I didn’t know what to do about it. And at first I wasn’t even aware it was happening. And by the time I was aware it was happening, it was already past the point of no return. Everything that I have learned since I see it coming, I can start doing coping skills and asking for help and doing the things that I need to do, long before it becomes so serious that it would need a more serious intervention. So understanding my own symptoms, my own moods, etc. doesn’t necessarily eliminate them, but it can prevent them from getting worse. And you know, my grandmother is very fond of saying that a stitch in time saves nine, which is an old-fashioned way of saying if you fix something before it gets too bad, it will be much, much easier to fix.
Gabe: And that’s what I mean about understanding bipolar disorder, to really limit how much it can affect your daily life. But yeah, it absolutely affects my daily life. How could it not?
Dr. Nicole: And I’m pretty sure I know the answer to this, but I just want to clarify, like, what do you say to the person who doesn’t have a great understanding of the fact that it touches everything?
Gabe: I really think you’re setting yourself up to fail. I really look at bipolar disorder like a bully, you know, think. Think about that jerk at work. That that person that’s just always trying to throw you under the bus. Right? That is how I look at bipolar disorder. The minute you think, oh, that person is not going to bother me when I’m in this meeting or isn’t going to mess with that project. That’s when you get blindsided. That’s the one they attack because you don’t see it coming. You’re much better off being vigilant everywhere. And I think a lot of people miss that.
Dr. Nicole: I love the bully analogy because just like that bully is coming for you, your bipolar disorder symptoms are coming for you. They’re not coming to make life easier. They are coming to make life harder.
Gabe: I agree with that 100%. 1,000%. We’ve already talked about this next question a little bit, but it’s worded slightly different and I think it might generate a different conversation. But the the specific question is what role does medication play in managing bipolar disorder?
Dr. Nicole: Medication is it’s the cornerstone of treatment for bipolar disorder, which may not be what you want to hear, but medication is largely the beginning of the conversation. There are other treatments, yes, but when it comes to managing your bipolar disorder, when it comes to trying to keep you in the middle and not have you too far on the depression end or too far over to the manic or hypomanic end? It really comes down to medication. A lot of times for a lot of people, and medication can be helpful and medication can be valuable, but medication is delicate. Medication has to be monitored closely. Medication needs to be constantly evaluated for whether it’s effective and for adjustments necessary and side effects. Medication is a big part, but it’s one that we owe a lot of attention to. So it is very important to see your Dr. Nicole to have conversations with your Dr. Nicole about medication. But let’s be real about it, y’all. Medication can also be one of your biggest frustrations when it comes to your bipolar disorder, because medication is going to be the thing that reminds you that you have this illness. The medication that you have to take however many number of pills every day. The fact that you can’t miss doses, the fact that you have to get blood draws to monitor these medications, the fact that sometimes these medications do not come with sexy side effect profiles. All of that can be some of your biggest frustration, but it also, in my opinion, is the most important part of managing your bipolar disorder.
Gabe: The role of medication cannot be overstated. I’ve never really heard in any vast quantities or seen any research of anybody managing bipolar disorder long term without medication. Unfortunately, I have seen a lot of examples of people who have gone off their medication and they’ve lived well for three, six, 12, 18, 24 months. And in that time, they tell everybody and their brother that they’re not taking bipolar meds and that they are doing great. This is, unfortunately, the part of the show where I remind people that bipolar disorder is cyclical. I’m fond of saying that bipolar disorder has an elasticity to it. It pulls and pulls and pulls, but without medication and without treatment. Eventually it does snap. And unfortunately, while those people love to talk about how they’ve gone off their meds and they’re doing just fine, they don’t go back and find everybody. When a bad outcome happens, when they end up in police custody, they end up inpatient or they end up, you know, attempting or completing suicide. Unfortunately, those people don’t say, hey, it turns out I was wrong. I want to reiterate very strongly that there is no shortage of people living with bipolar disorder who will go off of their meds and who will live well for what appears to be a significant amount of time. But in the grand scheme of things, a year of stability is not significant. When we consider a lifetime, people on medication are showing lifetimes of stability, not months or even a year or two of stability. I It’s a downer. It’s just a downer to discuss the role of medication, because it’s just such a bummer and it feels powerless.
Dr. Nicole: I know it feels powerless and I know it feels like a bummer, but I always like to flip that around and let’s be. What’s the word I want to use? People are going to roll their eyes at me and it’s fine. But I like to focus on the fact that I’m thankful that we do have these medications, and I’m thankful that we continue to have newer medications, and I’m thankful that we have options to help manage your bipolar disorder, because there was a time in this illness where we didn’t have nearly the number of medication options that we have today, and the treatment options were slim. But now you have options and you have variety, and we have all these things we can try that we just have not always had access to. So I choose to focus on that and I know I get it. Dr. Nicole easier for you to focus on that when you’re the one prescribing and not the one taking, but it’s still where I’m going to fall.
Gabe: All right, Dr. Nicole, are you ready to jump into the next question?
Dr. Nicole: So, Gabe, you know, you know, the family and friends, the loved ones. Those are my people. Those are the ones who are sliding in my DMs all the time. And.
Gabe: They love you. They love you so much.
Gabe: It hurts me a little bit. I gotta be honest. It hurts me a little bit. Like, why don’t they love me? I
Dr. Nicole: Uh? [Laughter]
Gabe: Love, I love my family and friends.
Dr. Nicole: That’s who I hear from the most. So I’m going to throw this question at you. How can family and friends support someone with bipolar disorder? I have my answer, but I know that you have a very I know that you have an opinion about this.
Gabe: I do, I do. First off, I want to say that if I knew the answer to this question, if anybody knew the answer to this question, dump trucks of money would appear on their lawn. This is probably the number one question that I get asked when I walk off any stage, or when I open up Q&A anywhere. Whenever you do an ask Gabe anything, what can I do for my bipolar husband. What can I do for my bipolar daughter? What can I do for my bipolar friend and I? I desperately want an answer to this question. All I have are a couple of ideas. That’s all I have. The first thing that I want to say is, never in the history of ever have we been able to order somebody not to be bipolar. And so often when I delve a little bit into family dynamics, I hear I told them to go to therapy. I told them to take their medication. I told them they were ruining their lives. I told them this would happen and they won’t listen to me. And I want to say that is correct. They will not. I would argue that even if they didn’t have bipolar disorder, parents, spouses, friends have been complaining since the beginning of time the number of times that they have seen someone they love getting ready to make a mistake, and they have warned them and they didn’t listen. This is part of the human condition, just not listening to the people around you, and especially if you have a parent child relationship or a spouse relationship that can become murky and quagmired really quick. My advice is always to try to partner. It’s always to say, I’m really worried about you. Will you go to the doctor if I go with you? Because I just can’t get through the workday thinking about this, and it would just make me feel so much better if you did this favor for me.
Gabe: My strategy is to figure out how you can talk to them so that they see you as help. I’m really worried about you. How can I help you? What can I help you do? And finally, there’s. There’s just so much to unpack here, but the last thing that I will say is, sometimes you might have to recognize that you need help. I talk to so many, especially parents, but also spouses, that they know their loved one is in trouble. But because of stigma and because of discrimination, they’re afraid to ask for help. They’re afraid to ask a clergy person or their general practitioner, Or even another family member. Grandma, grandpa and uncle. Somebody. They’re afraid to involve other people because they think they’re protecting that person. The reality is, is if you see your loved one in harm’s way and you try to handle it all by yourself, unless you are a psychologist or a psychiatrist or a mental health professional, and even then, you might not be the one. But especially if you don’t have frontline education on how to help that person, you may not be the best one, and I don’t know of anybody who would try to put out a house fire without calling the fire department, but I see so many people who are trying to save their bipolar friends and family member, and they don’t have the slightest bit of training. We need to ask for help, we need to expand it out, and we need to realize that we may not be the one to do the saving.
Dr. Nicole: Yeah. You said people ask you a lot. How do I support my fill in the blank? And my first question is always have you asked them? Because a lot of times we don’t just ask the he person, how can I support you? How can I best support you? When you’re romantic, how can I best support you when you’re depressed? How can I best support you? We just start giving them all of our directives on how they need to fix themselves. And we don’t often ask them, well, what can I do? Like, what can I do to support you during those times? And it’s best to ask those questions when they’re stable, when they’re not in the middle of it. I think just asking the question, but to me, the number one thing you can do to support your loved one, your, your whether it’s a spouse, a child, a friend, it’s to educate yourself about the illness because people are largely ignorant when it comes to bipolar disorder. People have no idea what bipolar disorder is. They don’t know what it’s not. They just have no clue and then that puts you in a place of giving really bad advice and crappy support. Because what you think you know about bipolar disorder is largely inaccurate and really clouded by all of the stigma, all the misinformation out there. So I think the very first thing you can do is educate yourself about the disorder so that you have a great understanding of what it is your loved one is going through.
Gabe: And if you’re listening to this episode right now, you’re doing just that. You’re educating yourself. But I also want to tell family members that so often it becomes about the person with bipolar disorder, and it stops becoming about you, the individual. The reality is, is your mental health matters as well. Your self-care matters as well. You need to be top notch. You need to take care of yourself. You need to be firing on all cylinders. So ignoring your own mental health in service of somebody else’s is not a good outcome for anyone. And I want to say to everybody, because people tell me, well, look, if my loved ones in trouble. I’m not worried about myself. I’m willing to sacrifice myself for them. I understand the sentiment, but in reality, what you have is somebody who’s in a mental health crisis trying to help somebody who’s in a mental health crisis. It’s not good. Self-advocacy is advocacy for your loved one. You being at 100% puts you in a better position to be ready to help your loved one, and I think that is a huge way that family and friends can support their bipolar loved ones by staying healthy themselves.
Dr. Nicole: Sure. I mean, put your mask on first. Sounds very cliche. However, it is accurate in this case. If you are barely holding on mentally, you cannot help your loved one with bipolar disorder if and when they find themselves in a mental health crisis.
Gabe: And that’s it. Those are the answers to the top ten most common questions asked about bipolar disorder. So first, wherever you downloaded this episode, please follow or subscribe to the show. It’s absolutely free and next, recommend the show. Tell people in support groups, share your favorite episodes on social media. Send somebody a text message, an email. Mention it at the water cooler. If you want to stand by the freeway and hold up an Inside Bipolar Podcast sign, we’re not going to stop you, because sharing the show with the people you know is how we’re going to grow. My name is Gabe Howard, and I’m an award-winning public speaker, and I could be available for your next event. I also wrote a book. It’s called “Mental Illness Is an Asshole and Other Observations.” You can get it on Amazon. But I’m telling you, you’re going to want to head over to my website and get a signed copy because I’ll throw in some swag. That website is gabehoward.com. You can also follow me on Instagram and TikTok @AskABipolar.
Dr. Nicole: And I’m Dr. Nicole Washington. You can find me on all social media platforms @DrNicolePsych or hop over to my website, DrNicolePsych.com.
Gabe: And we will see everybody next time on Inside Bipolar.
Announcer: You’ve been listening to Inside Bipolar from Healthline Media and psychcentral.com. Have feedback for the show? E-mail us at [email protected]. Previous episodes can be found at psychcentral.com/ibp or on your favorite podcast player. Thank you for listening.
