Wednesday, October 15, 2008

How to Be Well (Part 2)

I guess the real question is: What does it mean to be well? For me, the definition of wellness has evolved over time. I used to think that being well meant being "completely normal." I figured that once I'd beaten this illness, I would never evidence any bipolar symptoms again.

This year I decided to redefine what wellness means to me. While I feel good most of the time, I still sometimes have symptoms. As I've mentioned before, a few weeks ago, I began to have a very low energy level, which made it difficult to get up in the morning. Since Adderall works for me, I'm now taking 10-20 mg. every morning so I have no difficulty getting up.

The only problem with Adderall is that it sometimes produces a low-level hypomania. Again, for me, all that means is that I have a higher energy level than normal. In days past, that would mean that I talked too much, too fast, and too loudly, and sometimes felt irritable, and wasn't very patient. However, now that I know these are symptoms, I work hard to alleviate them.

So, I've decided that I still consider myself well even though I have to take Adderall, and I have a few symptoms that I try hard to mitigate. By coming up with a more realistic expectation of what constitutes wellness, I can feel like I've made great progress.

One of the difficulties of bipolar disorder--as far as I'm concerned--is that there aren't enough success stories. And maybe one of the reasons is because the goal is "total normalcy." But, what is "normal?"

I know plenty of people who aren't BIPS (bipolar) who feel depressed and remain so for months at a time. I know lots of non-BIPS who talk too fast, too much, and too loudly. I also know lots of non-BIPS who are irritable, impatient, and sometimes downright hostile.

In fact, I'm sure we all know people whose behavior appalls us, but who aren't concerned about it at all. Do you ever wonder why certain "normal people" don't monitor what they do or say, why they never apologize for their "bad" behavior, and why no thinks they're sick when they act out?

So, I figure that my self-discipline in controlling things is a sign of success. I'm proud that I'm so conscientious about keeping mood charts. I think it's great that I have a daily diary of what I accomplish, how much medication I take each morning, how my energy level is throughout the day, how much exercise I do, and note what time I go to bed at night, and any behavioral patterns that concern me.

When I was diagnosed as a BIP in 1993, I would have been thrilled if my doctor had said, "You're atypical bipolar II, but don't worry about it. I've got patients who take a small amount of medication, but are so disciplined that their condition hardly affects their lives at all. They keep mood charts and participate in a wide array of wellness activities and truly have their situation under control."

Tomorrow, I plan to write about my top 10 wellness activities!


Gianna said...

I think way too often normal variations of mood and energy get pathologized...I don't consider my normal mood changes, energy fluctuations or reactions to circumstances "symptoms" at all anymore...

though I do know I'm still having adverse drug reactions to the Klonopin I remain on that I am soon to discontinue. It's very clear that I get an emotional and physical reaction to it a couple hours after ingesting it at night and into the late morning. I start to feel better in the afternoon and evening...can't wait to be free!!

Jazz said...

I think that's an important distinction you make between "wellness" and "normalcy". Each of us has to decide what wellness means for us and then to shoot for it. For me, wellness means not having to be on a daily regimen of mind-destroying medications...but not being so rigid and closedminded about it that I can't see when I need some help, and conceding that it's okay to say, all right, things are a little hairy, I should probably take a trazodone tonight to help me sleep, or some ativan to calm me down.

Wellness Writer said...

Dear Gianna,
You pose an interesting point about whether "normal mood changes, energy fluctuations or reactions to circumstances" constitute symptoms.

In my case, I do monitor changes--because there were years when I didn't realize I was hypomanic and there were unfortunate consequences of that behavior.

But I would agree that all changes shouldn't be "pathologized."

As always, best of luck in your quest to be medication-free.


Wellness Writer said...

Dear Jazz,
I applaud your willingness to do whatever you need to in order to maintain your health. And as I recall, you've been well for more than four years (Am I right?).

I feel it's really important for BIPS to know that a person can be very sick on medication and fully recover!


P.J. said...

"...that being well meant being "completely normal." I figured that once I'd beaten this illness, I would never evidence any bipolar symptoms again."

I am still working on this statement. From what I gather, there'll ALWAYS be bipolar symptoms of some kind for the rest of my life. I don't know if I'm at the place to be able to accept that yet.

I know that my life has changed incredibly in the past year, and that I'll never be how I used to be. I am gained too much knowledge about myself and my disorder to ever go back that way. I consider myself a success story, and I know my close friends would agree.

In regards to being "normal", like my friend said, "normal is just a setting on a dryer." ;)

Maybe the fact for me is that I'll never be completely well until I accept the fact that I'll never be completely well.

Wellness Writer said...

It took me years to come to this realization, but I don't think it's a bad thing. When you think about it, people who have diabetes (my mother) or high blood pressure (my husband) need to monitor themselves as well.

I don't think this is any different. Quite honestly, most of my "so-called symptoms" are within the range of "normalcy." I could ignore them and go on with my life. But since I know they can be problematic, I chose to acknowledge them and monitor my behavior.

Yet, I certainly know non-BIPS who have way more issues that I do. And throughout my life, I've worked with people who may not have been diagnosed as sociopaths, neurotics, or "mentally unbalanced," but they surely were.

Bipolar disorder is considered a spectrum illness. There are people who have a few episodes and are well for years or maybe even the rest of their lives.

My husband has taken heart medication for fifteen years, and my mother suffered from adult onset diabetes and took insulin for many years.

Actually, both of them suffered more side effects than I currently do. All I have is a little dry mouth and sometimes a bit too much energy.

So...I consider myself lucky!


Gianna said...

I don't think this is any different. Quite honestly, most of my "so-called symptoms" are within the range of "normalcy." I could ignore them and go on with my life. But since I know they can be problematic, I chose to acknowledge them and monitor my behavior.

I think another way of seeing this is the idea of practicing mindfulness...all human beings can benefit from that...we all potentially can behave in less than perfect ways...I certainly try to stay aware of my present reality and respond accordingly to it at all times.

again, I do try to stay away from language of illness I don't believe it's helpful....I don't know of a human being who doesn't suffer...we've just been labeled and it makes it easier for us to think there is something wrong with us for suffering or having other mindstates that we choose to judge as "abnormal."

Rather than thinking of bipolar as a spectrum disorder I see being human as a spectrum experience. Life can bring just about anything to everyone regardless of psychiatric label.

Wellness Writer said...

All good points!

P.S. I'm off to play badminton.

Gianna said...

mmmm....have fun!! I wish I was fit for badminton these days...

Jazz said...

You are correct--four years since my last "episode", and three and a half years off meds (except the trazodone...that's only been a few months). My psych doc says I'm an anomaly...but he still won't "undiagnose" me or bandy about the word "misdiagnosis".

Have fun at badminton! Crush those twenty-somethings like the little bugs they are!

Maggie May said...

this is a great positive attitude. my husband has bipolar and has been more and more proactive and the last year has been amazing for him and us. great job! i have anxiety and panic and i really know how hard it can be...

Tamara said...

You probably already know that "what is normal" is what I am struggling with right now. It is like a switch was flipped and all of the sudden all of my abuse issues were history. But, this left me with a big question mark about who am I? What does it feel like to be normal? Those kinds of questions.

I am learning that the best thing I can do is relax and not try to define too strictly myself or anything I feel. I need to not worry about being normal and just stay in the moment and gently correct course when I feel out of balance.

I do think of myself as well. I just have to remember that well is not defined as perfect or completely problem free!

Wellness Writer said...

Well, I was considered atypical bipolar II, so I know what you mean.

I wonder if the unwillingness to figure that maybe it was a misdiagnosis or that you've "cured" yourself is why many people live in fear. Even if they haven't had an episode for decades, they always seem to worry if another one is around the corner.


Wellness Writer said...

Dear Maggie May,
Welcome to my blog. Yes, I think that being proactive with any condition, whether it's bipolarity, anxiety, cancer, diabetes, or heart disease is the key to achieving wellness.

Glad to hear that your husband is doing much better.


Wellness Writer said...

I do realize that this is what you're dealing with right now. And after years of being ill, this was one of my challenges as well.

It seemed like all I had done for a decade was to try and survive the depressions, and then suddenly I was well most of the time.

It took awhile to get out of the "survival" mode and into the "living" mode.


marja said...

I consider myself well, though I'm on a lot of meds to keep me that way, and that's okay with me. What also helps, as you know, Susan, is my lifestyle.

Yet there's something about having lived with this disorder for over forty years - with the severe depression, mania, and psychosis - that always keeps me remembering that it could happen again. I know I will never be completely healed. I don't take my wellness for granted and am very very grateful for it.

Yet...I can't help worrying when the old symptoms come back. The only answer is to keep on keeping on with the lifestyle that has proven so beneficial - spending time with friends (even if it's only on the phone), doing physical activities, working with my friends from Living Room (my support group), praying, blogging, etc, etc.

Hey, maybe I should post my own list, eh, Susan?

Wellness Writer said...

I'd love to read your list!


Mariposa said...

You nailed one important issue here so well again.

Wellness becomes an impossible quest for most people because we are after "normalcy" yet even that is hard to measure since there is really no clear standard of what is "normal". We, diagnosed as BIPs may find ourselves inclined to say I wish we are normal since that just means to most us, removing bipolar from our system...and since there is no way we can do that...we live a life of unwellness...NOT.

You are right...we can be well despite the medication. If the medication helps us adopt, balance and do the things we want to do, then we are well. Take note, I said do the things we want to do...not what "normal" people do...because we all have quirks...and so how is that? Huh!

My doctor told me when he was explaining to me what it means being BIPs not to worry. He said, come to think of it, we all have our extreme's a matter of managing it. You are lucky you are aware of your inclination to be mostly on the extreme than most I never considered it as an affliction...never. The only time I started to feel the challenges of BIPs was when I started reading stories about people having these challenges.

So, time to sing that song...I'm not crazy...but just a little unwell...which we all go through...regardless if we have BIP or not.

Going to the next post now. :)

Wellness Writer said...

I couldn't agree more. And when you think of it, we're lucky we just have bipolar disorder, rather than something more serious.

While most people wouldn't agree with that statement, they forget that bipolar disorder isn't life threatening, while cancer and so other illnesses are.