When it comes to mental illness, often our moods are “all or nothing.” We are either on top of the world or in the pit of despair. If we are not careful, our behaviors can reflect our emotions, leading to chaos in our lives and problems in our relationships with others.
When it comes to the emotional ups and downs of mental illness, we can fight the temptation to act on them by remembering the phrase “Keep the Pace.” In other words, let’s keep doing what we do when we are stable. Let’s keep showering and going to bed at a decent hour. Let’s keep eating as healthy as we can and exercising moderately. Let’s keep our social activities up, but not excessive, and our verbal and physical boundaries intact and closely moderated. Let’s maintain an appropriate number of projects, neither dropping them all due to inertia nor starting too many.
When I feel myself slipping into either an elevated or a depressed mood state, I will remind myself to “keep the pace” and not feed into the insanity of my disorder by changing my behaviors too drastically. Just like a marathon runner, who neither sprints nor ceases to run at all, I must pace myself to participate fully in the race, and then I will know peace.
In a recent study looking at the difference in neural activity between persons with bipolar I disorder who were experiencing mania, those with bipolar I disorder who were experiencing euthymia or a normal, non-depressed mood, and persons who did not have any psychiatric disorders and were considered “healthy controls,” researchers found some significant differences in two brain networks.
The first was in the Dorsal Attention Network (DAN), which is a group of regions in the brain that plays a large role in our internally motivated goals using our visual attention and short-term memory processes. In other studies, increased activity is evident in the DAN after the presentation of cues indicating where, when, or to what participants should direct their attention.
In this study, those individuals who were manic had significantly higher levels of activity in their DAN compared to the euthymic group and the healthy control group, possibly explaining the often apparent hyperattention, arousal and emotional response of those experiencing mania to external stimuli.
The second brain area assessed was the Default Mode Network (DMN), which is a group of brain regions that shows a lower level of activity when we are working on a particular mental task like paying attention, but higher levels of activity when we are doing more generic thinking tasks such as daydreaming, recalling memories, guessing about the future, monitoring the environment, speculating on the intentions of others – just thinking without any task-oriented goal in mind. Recent research has begun to find connections between the DMN and mental illnesses like anxiety and depression. Also, meditation is thought to be related to the DMN, which may be why its influence in well-being is significant.
Of particular note in this study, was the fact that those with bipolar disorder in a euthymic state showed hypo-connectivity in the dorsal nodes of their DMN compared to the mania group and healthy control group. The mania and healthy control groups showed the same connectivity.
Does this mean that the euthymic group was more relaxed, less worried about the past and future, less concerned about their surroundings and the behaviors of others than the other groups? Even the “healthy” group? I don’t know. The researchers didn’t comment on what this particular finding suggested other than the fact that this dorsal node is the exact location that corresponds to the target for transcranial magnetic stimulation (TMS) for the treatment of depression, even though they made sure to reiterate the fact that the euthymic group was not depressed.
The researchers pointed out the fact that their study’s results contribute to a body of growing evidence that points to bipolar mania as a behavioral pathology due not to circuit disruption but rather increased coherence (connectivity).
As far as the hypo-connectivity of the dorsal nodes of the DMN in the euthymic group goes, the researchers were not sure if this was due to a compensatory mechanism of the disorder trying to right itself or if it was in fact still part of the diseased state.
– Diagnosis was determined using the Structured Clinical Interview for the DSM-IV (SCID)
– Limitations of the study included a small sample size of 23 manic, 24 euthymic, and 23 healthy controls.
– There were no significant differences in participant age, sex, and medications
In the largest MRI study on people with bipolar disorder, researchers determined that the areas in the brain that control inhibition and emotion – the frontal and temporal regions – are significantly different than those of people without the disorder.
The study was led by the University of Southern California Stevens Neuroimaging and Informatics Institute at the Keck School of Medicine of USC: ENIGMA (Enhancing Neuro Imaging Genetics Through Meta Analysis). It involved 76 centers and included 26 different research groups around the world.
The researchers measured the MRI scans of 2,447 adults with bipolar disorder and 4,056 healthy controls. They also looked at the effects of commonly used prescription medications, age of illness onset, history of psychosis, mood state, age and sex differences on cortical regions.
Some findings suggest those with a history of psychosis have greater deficits in the affected regions and there are “different brain signatures in patients who took lithium, anti-psychotics and anti-epileptic treatments.”
Further studies will look at how these medications affect brain measures and subsequently, modify symptoms and outcomes for patients. “This new map of the bipolar brain gives us a roadmap of where to look for treatment effects,” said Thompson, an associate director of the USC Stevens Neuroimaging and Informatics Institute at the Keck School of Medicine.
I think it is awesome that they are finding physical proof of the nature of bipolar disorder; that it is not some myth or personality flaw or weakness or moral shortcoming. These findings can give people like me the validation they need to know that they are not “crazy,” but ill.
Having a brain that doesn’t function normally is no different than having a pancreas that doesn’t function normally (diabetes.) Granted the symptoms of bipolar disorder may affect those around the individual more severely than the symptoms of diabetes, but the general analogy is still the same.
I have been reading thoughts online and hearing opinions in real life regarding a Netflix series about a teenage girl who dies by suicide, and what questions this show raises about the media’s responsibility for portraying triggering, and even instructional, scenes on how to take one’s own life. In response to this, I would like to refer to an article published this month by Lisa Firestone, PhD in Psychology Today, who states:
“Guidelines on the media’s portrayal of suicide include never glamorizing or sensationalizing it in any way, period. Specific means for suicide should not be shown or related. Any depiction of suicide should include a story of a survivor who is living proof that the suicidal state can be temporary…In addition, any discussion of suicide should include resources for people who may be in crisis or are worried about someone they know. Media should also include a list of warning signs for suicide, which can help people identify when someone’s at risk.”
I feel distressed because so many preteen and young teenagers are watching this show, which has a ‘MA’ rating. I feel worried because kids with mental illness are watching this and possibly being triggered into self-harming behaviors and emotional anguish. And, God forbid, if any one of them is moved to end their life because this show’s message gives them the final reason to do it or the final way to go about doing it.
Don’t get me wrong…It is important to talk about suicide to raise awareness and get people who need help to open up and reach out for it, but like Firestone says, without following proven recommendations on how to report on suicide, “we risk contributing to individuals’ suicide risk and even creating contagion, especially among teens.”
Please remember, the suicide state is often passing and temporary. It can be a trance-like state that can leave people with diminished awareness of the fact that if they wait things out they may regret even considering suicide at all. Many people who have made serious attempts often have these types of regrets, because like everyone says, things do get better. Nothing ever stays the same. Don’t give up just before things change!
Warning Signs of Suicide
(from the American Association of Suicidology)
- Talking about wanting to die.
- Looking for a way to kill oneself.
- Talking about feeling hopeless or having no purpose.
- Talking about feeling trapped or being in unbearable pain.
- Talking about being a burden to others.
- Increasing the use of alcohol or drugs.
- Acting anxious, agitated or recklessly.
- Sleeping too little or too much.
- Withdrawing or feeling isolated.
- Showing rage or talking about seeking revenge.
- Displaying extreme mood swings.
When I was first diagnosed with Bipolar Disorder my life was in complete chaos. I had a job that didn’t have set hours, with responsibilities and a caseload that changed on a daily basis. Plus, I had three small children with a husband who worked varying hours, including nights and weekends. My days were anything but routine.
Fast forward five years later, and I am a stay-at-home mom with a set routine of getting up at the same time every morning to get the kids off to school, work on house chores during the day as my illness allows me, rest in the afternoon, be there for the kids when they get home from school and in the evening for school and sport events. I also take my medications on a routine schedule and go to bed around the same time every night.
Researchers have demonstrated that routines can help those with bipolar disorder by balancing their sleep/wake cycles. Routines can also help those with anxiety by making daily activities more manageable and predictable. Routines help us get more stuff done by keeping us on task, thus providing more time for rest and relaxation, which is also good for mental health. And routines give us a sense of control over our lives since we get to choose what we include in them.
I do find that as my illness symptoms creep back into my life, there is sometimes the need for flexibility in my routine. For example, when I am fatigued from depression, I may spend more time in bed and less time on chores.
However, after a few days or a week, my routine usually kicks back in and I am at least doing a little bit each day. While I might not feel motivated to engage in my routine, my routine motivates me to get things done, because it is what I am used to doing. It doesn’t feel right to not do it.
What about you? Are routines good for your mental health or do you prefer an unstructured lifestyle?
When we have a mental illness, it’s imperative to learn all we can about it in order to understand it, because understanding leads to the best collaboration with healthcare professionals when making decisions for our care and medication and treatment choices. Understanding leads to the best advocacy for ourselves when dealing with employers, family, and friends who may or may not get how mental illness affects our performance and behaviors. Understanding leads to self-compassion and patience during times when we are feeling low and can’t do what we want. Knowing it is part of the disease and not part of our character can help save our self-esteem and self-worth.
Today, I will ask my healthcare professional for, or research on my own, two sources to learn something I didn’t already know about my mental illness.
Worrying is a natural part of life. There isn’t one adult person who hasn’t worried about something at some point in his or her life. It is when the worry starts affecting your mental health by way of anxiety and depression, and your physical health (your sleeping, your eating, ulcers, etc.) that it becomes a problem.
We live in a time-based reality. Past, present, and future. Worrying is a past and future minded activity. We are either thinking about something in the past that has already happened, or thinking about something in the future that hasn’t happened yet (and sometimes about something in the future that may or may not even happen.)
This leaves the present time as the only place for us to escape our incessant worrying. We do this by engaging in activities that distract us and keeping our focus on the task at hand; by paying close attention to our surroundings at all times – really listen to the birds tweet, fully take in the grass’ green and the sky’s blue; listen to each word of the song on the radio, each note that is played instead of daydreaming about your worries while driving in the car.
This is called being “mindful”, and it keeps us out of past and future time and out of worrying. The mind doesn’t like it and will try to pull you back into past and future, but you can fight it by consciously choosing to stay in the present moment by never doing anything on “auto-pilot” again. Feel whatever you do with all of your senses and you will be in mindfulness.
Today, I will practice mindfulness or present-time living, and I will know freedom from worry and anxiety, even if only for brief moments.