Bipolar4LifeSupport

None of us ever set out to live a life with chronic pain and illness, but it happens. There comes that moment when you are sitting in yet another doctor’s office going over your symptoms for the third time that week, and the physician is simultaneously squinting his eyes, trying to make sense of your laundry list of complaints while scribbling something in your file — when you realize that your story might not ever have a Cinderella ending.

You panic.

You may throw things (when you get home).

Niagara Falls begins to erupt from your eyes.

And then gradually, over time and much heartache, you embrace Plan B.

My Plan B was immersing myself into the wisdom of Toni Bernhard’s writing on the topic of chronic illness. In my opinion, there’s no one who understands the frustrations of being unfairly stymied in your life by an illness as well as Bernhard, but who offers a hopeful perspective without charging you with a bunch of actions that promises a “cure” like so many other self-help books do. Bernhard, a former law professor and dean of students at the University of California-Davis, caught a viral infection in May of 2001 on a trip to Paris and has been mostly housebound — often bedbound — since.

I read her first book, How To Be Sick, at a critical time in my recovery a year-and-a-half ago when I decided to start living around my symptoms instead of fighting against them on an hourly basis. Her insights have led me to peace, and helped me to embrace my illness in a way that has substantially reduced my suffering. Now, she has just published a new book, How to Live Well With Chronic Pain and Illness. Like her first book, it’s packed full of helpful advice, including skills to help with every day, how to communicate with family and friends, managing toxic thoughts and emotions, and dealing with isolation and loneliness.

Here are just a few favorite insights of mine that she offers in her book to help you live better with chronic pain and illness.

1. Be Kind to Yourself

One of my favorite chapters in Bernhard’s book is called “Letting Go: A Not-To-Do List for the Chronically Ill,” in which she compiles a fantastic list of eight things not to do:

• Do not spend your precious energy worrying about how others view your medical condition.
• Do not treat discouraging and disheartening thoughts or emotions as permanent fixtures in your mind.
• Do not ignore your body’s pleas to say “no” to an activity.
• Do not undertake a treatment just to please whoever is pressuring you to try it.
• Do not be angry when people in your life don’t respond as you’d like.
• Do not get hooked into believing you always have to “think positively.”
• Do not put your pre-illness life on a pedestal.
• Do not call yourself names or otherwise speak unkindly to yourself when you break one of your not-to-do rules.

They are all ways of learning how to be kind to yourself, which Bernhard would say is the most important lesson of all. “Self-compassion always comes first,” she writes. “If you think that treating yourself with compassion is too self-absorbed, remind yourself of the Buddha’s words: ‘If you search the whole world over, you will find no one who is dearer than yourself.’” We so often associate the word “kindness” with our actions to others, but it’s equally important to treat ourselves with respect and compassion.

2. Ask for Help

We’ve been taught that asking for help is a sign of weakness. In our culture, independence is valued over dependence. Learning how to ask for help takes practice for many of us. It’s a skill. Bernhard outlines some steps to hone this skill, and she reminds us that asking for help can actually be an act of kindness toward others. She writes, “Allowing them to help when you’re struggling with your health makes them feel LESS HELPLESS in the face of the new challenge in your life. It can mean a lot to someone to be able to aid a friend or family member who is struggling with his or her health.”

3. Learn How to Say ‘No’

This lesson has been one of the most difficult ones for me as a stage-four people-pleaser. Whenever I summoned up the courage to say “no” as a young girl, I endured silent treatments and other fun stuff. Going into my second decade with a chronic illness, however, I have no choice but to utter the two-letter word with regularity. That is, if I want to reduce my symptoms as much as possible. In responding to other people, Bernhard relies on Buddha’s teaching on skillful speech — we should speak only when what we have to say is true, kind, and helpful. So when someone asks her to do something, she asks herself, “Would saying ‘no’ as opposed to ‘yes’ betrue to myself? Would saying ‘no’ as opposed to ‘yes’ be kind and helpful to myself?” Think about this the next time you are asked to do something: Will your response be true to yourself, reflect your values, and EASE your suffering, as opposed to intensifying it? Or are you responding out of social pressure and a pattern of people-pleasing? Bernhard says it gets easier to say “no” as you begin to do it more often.

4. Don’t Feed the Want Monster

“Our desire to satisfy the Want Monster can feel so intense that we can talk ourselves into believing that getting what we want is necessary to our very ability to be happy,” writes Bernhard. For a long time, my deepest desire was to regain the good health that I enjoyed in my 20s. I could eat pizza and ice cream without suffering painful consequences. I enjoyed hosting parties with my husband. I didn’t have to keep a mood journal and assign each day a number between 0 (no death thoughts) and 5 (worrisome suicidal ideations), along with the day in my menstrual cycle, medications and supplements taken, and food and beverages consumed. These two lines in Bernhard’s book enlightened me on how much energy I was wasting on trying to get back to my 27-year-old self: “The type of happiness that comes from satisfying the Want Monster is short-lived — because nothing is permanent … This conviction that the key to happiness is satisfying our desires sets us up for a big dose of disappointment and dissatisfaction with our lives.” After falling into that trap herself, she now realizes that the happiness that she wants comes from being content with her life as it is — and that is very attainable. She writes:

This happiness comes from making peace with the stark realities of life — that it’s a mixture of pleasant and unpleasant experiences, easy times and hard times, getting what I want and not getting what I want. It’s that way for everyone, and has always been. This happiness comes from opening my heart and mind to engage each day fully, even though I know it may be a day in which the Want Monster goes hungry.

5. Practice Mindfulness

“Mindfulness is the practice of turning your attention with care to the experience of the moment,” Bernhard explains. Her chapters teach us how to apply mindfulness to our illness — that is, how to pay attention to our physical and mental discomfort in a way that brings us to peace with our lives as they are at the moment. This can be done inside or outside the practice of formal meditation. It is about responding skillfully to emotions that can hijack our mind and identifying stressful thought patterns that can so often trigger physical reactions in the body. With practice, we can learn to catch the stories we tell ourselves that work against our well-being and mindfully let them go. Bernhard writes:

It took several years of chronic illness for me to recognize that I was causing myself undue mental suffering by spinning stressful stories about my physical discomfort and then accepting them as true without question simply because I had thought them. Mindfulness practice was the principle too that helped me realize was I was doing.

Halloween is a time when we have fun with the feeling of being afraid, so I thought I’d write about our fears, phobias, anxieties — things that shorten our breath, quicken our heartbeats, and sometimes outright disable us.

Some of us shut our eyes and hold our breath as we ride the elevator to the 10th floor of an office building, while others pray the Rosary inside that coffin-like enclosure when getting an MRI. I am afraid of heights — in particular driving over the Chesapeake Bay Bridge. It doesn’t look all that menacing, but the structure spans more than 4.3 miles and is 200 feet high in places.

I’m obviously not alone with my jitters. Two years ago, Inside Edition did a story on it, calling it quite possibly the scariest bridge in the world. It was also on Travel + Leisure’s list of the 10 scariest bridges in the world — the only other two American bridges being the Mackinac Straits Bridge between Mackinaw City and St. Ignace, Michigan, and the Royal Gorge Bridge in Cañon City, Colorado.

The Bay Bridge connects Maryland’s eastern and western shores (Annapolis is on the western shore), so kids’ sporting events on the eastern shore present a real problem for a mom with gephyrophobia (fear of crossing bridges — yes, there’s a word for us!). Usually, I make my husband take off work to drive Katherine or David across the bridge. But the other night he was out of town, so I was forced to face my fear, which is usually the way phobias are addressed.

My strategy was to follow these four steps, which, once I was on the other side of the bridge, I realized actually apply to everything we don’t want to do, and to living with depression in general.

1. Focus on the Yellow Lines (or What’s Right in Front of You)

This is true of so many things — if we can keep our view on just what is in front of us, instead of the really high span a mile ahead, we have a better shot at staying calm.

Ironically, when I swam UNDER the bridge — where many people freak out because, in some places, you’re swimming in 174-foot deep water — someone told me to count the concrete structures along the way and never try to gauge how far it is to the other side.

It was sage advice. Whenever I looked up and tried to figure out how far it was to the shore, my breath became labored and swimming became much more difficult. But if I concentrated on counting my strokes and the structures, I made better time, and I forgot that I was a mile away from land on each side.

When I’m driving over the bridge, I do much better when I kept my gaze down at the yellow lines.

This is also true if you are in the midst of a depressive episode. In that case, the yellow lines are 15-minutes segments of time, and I tell people to take it 15 minutes at a time, no more.

2. Keep Your Cheerleaders Nearby

Conquering your fear is much easier when you have cheerleaders to accompany you. This is true when you challenge yourself in any regard, from running a 5K to giving a talk at an event.

I remember the time when a friend couldn’t get into a skyscraper elevator in New York City until my sister offered to ride up with her.

“Mom, this is not that big a deal,” my son reminded me as we paid the $4 toll to get across the bridge.

Of course, the cheerleaders can also distract you, which is a plus; on the way back, my kids were fighting over a Chick-Fil-A milkshake, grabbing it out of each other’s hands just as we reached the highest part of the bridge. My attention turned from the little yellow lines to screaming, “Stop it already! Can’t you see Mom’s not having fun?!”

3. Watch Your Breath

In addition to counting the yellow lines, I practiced a modified Pranayama, the first breathing exercise of Bikram yoga, while crossing the bridge. Obviously, my hands were on the steering wheel and I couldn’t throw my head back, but I inhaled to a count of six breathing in through my nose, and then exhaled to a count of six breathing through out my mouth.

When you breathe deeply, you stimulate your vagus nerve, which extends from your medulla oblongata, located in the brain stem, to the stomach. This long nerve links your central nervous system and your peripheral nervous system. It is often considered a bridge between between our conscious minds (“I am driving across a really high bridge”) and subconscious minds (“I’ll never be able to overcome my fears”).

By stimulating the vagus nerve and the parasympathetic nervous system, we release anti-stress enzymes and hormones, such as acetylcholine, prolactin, vasopressin, and oxytocin.

The first thing that happens when we panic is that our breath grows shallow and the loss of oxygen sends an alarm throughout our body that we are in harm’s way, which further paralyzes our thoughts and our biological systems. Stopping this reaction as it is happening is much more difficult than keeping it from happening to begin with, so it’s best to slow your breath from the beginning when you’re in a fearful situation, and make sure you keep it at a deliberate, measured pace until you’re on dry land or out of the elevator.

4. Apply Some Humor

I was very glad that a friend asked me to watch Bob Newhart’s video Stop It last week before I attempted the bridge drive. I apologize in advance if anyone finds the video offensive, but for those of us who have endured some really bad therapy sessions and have fears that make absolutely no sense, it is welcome comic relief.

A woman who comes to see Newhart’s character, Dr. Robert Hartley, PhD, for therapy is afraid she is going to be buried alive in a box, and Bob simply says, “STOP IT!”

She goes on to say she has bad relationships with men, is bulimic (I realize this is sensitive, but I also had an eating disorder and I appreciated the humor), and a list of other things, and all he says is “STOP IT!”

At the highest point of the bridge, I did begin to panic a little and feared that I was going to have a bona fide panic attack.

“What if I can no longer control my foot and I accidentally hit the accelerator, smashing us into this truck in front of us, and we go over the side,” I thought to myself. “Maybe I should open all the windows now so the kids and I can climb out, because the weight of the water will make it impossible for me to punch through the glass …” The ruminations were just beginning when I said to myself, “STOP IT!” and laughed, remembering the video. “This is insane. Just STOP IT!”

For many people, the beginning of autumn triggers anxiety with its shorter days, reduced sunlight, changes in schedules, and allergies. Fortunately there are many foods and spices during this season that can help us to stay emotionally resilient and boost our mood. Enjoy the following foods as the leaves begin to fall and the temperature cools. They contain the right mix of nutrients to help keep you calm.

1. Pumpkin Seeds

Pumpkin seeds are one of Mother Nature’s most potent mood boosters. They’re chock-full of zinc (containing 23 percent of our daily recommended value in just one ounce), which Emily Deans, MD, calls an “essential mineral for resiliency” in her Psychology Today blog Zinc: An Antidepressant. The mineral also increases our ability to fight off inflammation, which can cause depression and anxiety. In addition, it’s rich in magnesium, our calming nutrient: According to a 2012 study in the journal Neuropharmacology, magnesium deficiencies induce anxiety, which is why the mineral is known as the original chill pill.

2. Squash

Squash was already one of my favorite fall foods before I knew it was packed full of mood-boosting ingredients. Just one cup of butternut squash contains 15 percent of the daily recommended value of magnesium, 17 percent of potassium, and 18 percent of manganese — all critical minerals to keep you sane. One cup also contains a whopping 52 percent of vitamin C, which gives a helping hand to our immune system and to our entire central nervous system.

3. Cinnamon

Cinnamon was used as early as 2000 BC in ancient Egypt to treat a host of different health conditions. A study at Wheeling Jesuit University in Wheeling, West Virginia, showed that even smelling cinnamon enhanced cognitive performance. The spice is especially good for anxiety and depression because it helps regulate blood sugar. And one teaspoon provides 22 percent of the daily recommended value ofmanganese, a critical trace mineral that helps with nerve function and connective tissues, aiding the central nervous system in general. In addition, it plays a role in neutralizing free radicals that can damage cell membranes and DNA.

4. Turkey

If you’re fretting about all the family drama that happens at Thanksgiving, rest assured that the turkey will be helping you stay sane. It’s a good source of the amino acid tryptophan, which helps your body produce the feel-good chemical serotonin.

5. Turmeric

I throw the spice turmeric into the fall foods category because I start experimenting with it once the weather turns cool. This yellow spice that we eat in different kinds of curry contains a natural anti-inflammatory agent, curcumin, that helps mitigate depression and anxiety. The abstract from a 2014 study in the Journal of Affective Disorders reads:

Curcumin, the principal curcuminoid derived from the spice turmeric, influences several biological mechanisms associated with major depression, namely those associated with monoaminergic activity, immune-inflammatory and oxidative and nitrosative stress pathways, hypothalamus-pituitary-adrenal (HPA) axis activity and neuroprogression. We hypothesised that curcumin would be effective for the treatment of depressive symptoms in individuals with major depressive disorder.

6. Apples

As I mentioned in my blog 10 Foods I Eat Every Day to Beat Depression, apples are high in antioxidants, which can help to prevent and repair oxidative damage and inflammation on the cellular level. They’re also full of soluble fiber , which balances blood sugar swings. One of my favorite fall snacks is some almond butter on apple slices, so I get my omega-3 fatty acids along with some fiber.

7. Eggplant

In addition to being a good source of fiber, copper, vitamin B1, and manganese,eggplant also contains important phytonutrients, including phenolic compounds and flavonoids, that are potent antioxidants. One study found that anthocyanin phytonutrients in the skin of eggplants, called nasunin, protects brain cell membranes from damage by zapping free radicals and guarding the lipids (fats) in brain cell membranes.

8. Sweet Potato

Just one baked sweet potato provides 214 percent of our daily recommended value of vitamin A (an antioxidant superpower), 52 percent of our vitamin C, and 50 percent of our manganese. This healthy starch is also full of copper, pantothenic acid, vitamin B6, biotin, and potassium — all very helpful in fighting depression and anxiety. Sweet potatoes contain anthocyanin pigments and other flavonoids that have been shown in studies to have strong anti-inflammatory and antimicrobial activities. According to one study published in the Journal of Biomedicine and Biotechnology:

Because of their diverse physiological activities, the consumption of anthocyanins may play a significant role in preventing lifestyle-related diseases such as cancer, diabetes, and cardiovascular and neurological diseases.

9. Chamomile Tea

Chamomile is one of the most ancient medicinal herbs and has been used to treat a variety of conditions including panic and insomnia. Its sedative effects may be due to the flavonoid apigenin that binds to benzodiazepine receptors in the brain. Chamomile extracts exhibit benzodiazepine-like hypnotic activity as evidenced in astudy with sleep-disturbed rats. In a study at the University of Pennsylvania Medical Center in Philadelphia, patients with generalized anxiety disorder (GAD) who took chamomile supplements for eight weeks had a significant decrease in anxiety symptoms compared to the patients taking placebos.

10. Bananas

Bananas are rich in potassium, which aids mood. A 2008 study published in the British Journal of Nutrition found that a high-potassium diet helped relieve symptoms of depression and tension in participants. It’s an important electrolyte that regulates blood pressure and PH balance. Bananas also contain tryptophan, which increases brain serotonin and, according to some studies, can be an antidepressant for mild-to-moderate depression. The vitamin B6 in bananas helps convert the tryptophan into serotonin while soothing your nervous system. Bananas also have melatonin, which aids sleep and regulates our body’s natural rhythms, as well as iron, which can help fight fatigue.

For anyone with an inclination to use food as comfort — which basically includes us all — the two months between Halloween and the New Year provide one temptation after another. For me, it starts the hour the trick-or-treaters have left and I assess the supply of Tootsie Rolls, Kit Kats, and Reese’s Peanut Butter Cups that didn’t make it into the pillow cases or plastic pumpkins of our guests. I tell myself that they’re absolutely off-limits as I climb up on the kitchen counter to hide them in a place that requires much physical effort to get to. Then come all the holiday festivities whereeverything I’m not supposed to be eating and drinking (sugar, gluten, dairy, alcohol) is there, available, in my face, taunting me … “Come on, you know you want me … I can make you feel better.”

For many of us, the holidays are filled with stress, and the easiest, safest, most affordable place to relieve that stress is in a plate of mashed potatoes or pumpkin bread, a box of Christmas cookies, and lots and lots of red wine. I always think about the scene from Mall Cop when emotional eater Paul Blart (Kevin James) is spreading peanut butter on his bread, saying “Pain, go away.” But for many of us, the more we give in to the patterns of emotional eating, the deeper our pain gets, especially for those of us who are intolerant to sugar, gluten, dairy, and alcohol — which is a high percentage of people who struggle with chronic depression and anxiety.

But if you’re prepared with some action items, it’s possible to not get trapped into emotional eating even during the holidays. Here are a few ways you can avoid turning to food for comfort and exercise discipline during this self-indulgent season of the year.

1. Nibble on Dark Chocolate in the Morning

When I was newly sober, my sponsor told me to eat chocolate or enjoy a chocolate milkshake whenever I had a craving to drink. She was mostly right. Since sugar can often cancel out the beneficial properties of this food, it’s best to aim for dark chocolate that’s at least 85 percent cocoa or higher. Dark chocolate often satiates the urge to engage in addictive behavior for a few reasons: First, it has one of the highest concentrations of magnesium in a food, with one square providing 327 milligrams (mg), or 82 percent, of your daily value — and magnesium is our calming friend. According to a 2012 study in the journal Neuropharmacology, magnesium deficiencies induce anxiety, which is why the mineral is known as the original chill pill.

Dark chocolate also contains large amounts of tryptophan, an amino acid that works as a precursor to serotonin, and theobromine, another mood-elevating compound. I find that eating a few squares of Lindt’s 90% Cocoa Excellence bar a day — oftentimes in the morning — quiets my impulse to binge the rest of the day on sweet breads and chips, and the Reese’s cups up above the kitchen cupboards are terrible for my mood. Maybe this is related to research from Tel Aviv University that shows that including dessert as part of a balanced 600-calorie breakfast full of protein and carbs could help dieters lose weight and keep it off.

2. Keep a Supply of Safe Comfort Food

Dark chocolate is one of my safe comfort foods. Four squares of my 90% cocoa Lindt bar is a serving, so I allow myself to have four most days — especially during the eating season of November and December. In order to keep your hands away from problem foods, it’s best to have a supply of comfort foods that you can eat. Here are some others of mine:

• Sparkling water. When I put a lemon in it, it’s pretty close to qualifying as a party beverage, and unlike alcohol or Coke or even Diet Coke, I can safely consume bottles of it if I need to binge on something.
• Lactose-free kefir. Sounds lame, I know, but it’s rich and creamy, and is the only dairy item that doesn’t make me depressed, constipated, or bloated. Plus, the kind I drink (Green Valley Organics) is loaded with probiotics — 10 live and active cultures — so it supplies me with good bacteria for my gut, which in turn helps my mood.
• Pumpkin seeds. They’re full of zinc (a natural antidepressant), magnesium (our calming friend), manganese, and plant-based omega-3 fats. According to bestselling author Joseph Mercola, DO, pumpkin seeds are nutritional powerhouses and can curb the urge to fill up on junk.

3. Bring Your Own Food to Parties

If you’re invited to a party where you know there’s going to be a spread of foods that you want to binge on, prepare a dish ahead of time that you know you can eat — and eat a lot of. For example, recently I knew we were going to this party where I would be tempted to gorge on a coconut cake that my friend was making. It’s my weakness. So I made a really delicious kale salad (with the right ingredients, it doesn’t taste like something nutritious!) and filled my plate with it. I also took a bottle of sparkling water in case my friend didn’t have any non-alcoholic beverages, and a bar of dark chocolate. I did binge on the kale, sparkling water, and dark chocolate, but managed to control myself from inhaling the other items that were telling me that they could take my pain away — like the coconut cake.

4. Keep a Food Journal

Keeping a food journal seems like a lot of work, but it’s going to help you in several ways. First, it makes you accountable. Ever since I started to record everything I eat, I’ve been much more aware of what I put in my body. As I’m grabbing for a few sips of my daughter’s chocolate milkshake, I’m thinking about the journal and how I’ll have to record what is about to go in my mouth. It also helps you connect the dots between your diet and your mood. That’s how I realized that sugar, more than anything other ingredient, was causing my mood swings. For two or three days after a slip, depression revisited, so I knew there was a cause and effect between the food and my negative ruminations.

Finally, it’s not a bad idea to leave some room in your food journal to write about your thoughts. Journaling has been proven as an effective, inexpensive form of stress relief. Oftentimes, when we record our thoughts, it gives us an opportunity to assess them and to let them go. For 20 years, James W. Pennebaker, PhD, professor of psychology at the University of Texas in Austin has been studying the effects of journal writing. “When people are given the opportunity to write about emotional upheavals, they often experience improved health,” Dr. Pennebaker says. “They go to the doctor less. They have changes in immune function. If they are first-year college students, their grades tend to go up. People will tell us months afterward that it’s been a very beneficial experience for them.”

5. Sit Down When You Eat and CHEW Your Food

One of the reasons that French people don’t get fat, according to a Cornell study, is that they can better gauge when they are full; they use internal cues (“I’m no longer hungry”) to know when to stop eating, unlike Americans who stuff their faces while watching TV or graze all day long, never sitting down for an official meal. The French may eat baguettes and brie, croissants and butter, and all the other forbidden foods, but they enjoy them at a table, their butts on a chair, with friends or family. They also chew and savor their food, which allows for better digestion — and an earlier signal of when to stop bringing the fork to the mouth. Next time you’re tempted to eat something standing up — in transition here or there — stop. Instead, put the food on a plate and take it over to a table, being mindful of the experience of eating.

6. Distract Yourself

Like any addiction, distraction is often the best antidote for emotional eating. Let’s say you’re in the kitchen right after your neighbor has just dropped off a batch of Christmas cookies. GET THE HELL OUT OF THERE. Sorry, but if sugar is as addictiveto you as it is to me, and makes you feel as horrible as it does me, you can’t put yourself in danger like that — not during the holidays when there’s already enough to drag you down. So go to another room and start surfing stupid YouTube videos, like this great version of the 12 Days to Christmas or the Classics of Saturday Night Live. Begin a trashy novel or do some other mindless activity that will allow you to forget about the cookies for a while, until you can reenter the kitchen with a little more resolve.

7. Find Another Comfort Item or Activity

Food is a perfect comfort activity because it’s so easy, and its effects are immediate.Ben & Jerry’s gives us a carbohydrate high by the time we dig into the pint for our second bite. But if we can swap that behavior for another comfort activity, we can train our brain to go somewhere else for comfort. Other possibilities: yoga, exercise, journaling, reading spiritual literature, meditation, online support groups, and twelve-step meetings. Going on a nature walk is almost as easy as opening the fridge, and according to research, it reduces ruminations and boosts feelings of well-being. Developing a regular yoga practice in the last two months has definitely helped me control my addictive tendencies. Other people I know swear by swimming or running. And others opt for meditation.

8. Get an Emotional Eating Buddy

You might not need a support group to rein in your urge to binge. Maybe you just need to talk to someone else who struggles with the same, especially during the holidays — someone to email when you feel the urge to deal with some upcoming stress by stuffing your face with everything in your pantry with an okay expiration date. You probably know of someone. If you don’t, you might want to check outProjectBeyondBlue and look for someone who speaks your language, a fellow foodie with whom you can exchange messages to keep you accountable and give you some support.

9. Weigh Yourself Every Morning

I know this step seems cruel, especially in November and December. But it’s about accountability — like recording everything you eat into a journal. A 2014 study inHealth Psychology led by Jessica LaRose, PhD, an assistant professor of social and behavioral health at Virginia Commonwealth University School of Medicine in Richmond, found that the overweight or obese adults who weighed themselves every day over the course of 18 months lost more weight, on average, than those who didn’t. The researchers found no increase of disordered eating among the group that checked their weight every day. Regular feedback contributed to a sense of continued awareness and self-reinforcement, which further promoted behavioral changes.

Ten years ago, when I was first diagnosed with bipolar disorder, I was working with a psychiatrist who wanted me to alert him at the first hint of a creative thought. Whether it was an article idea or, God forbid, a concept for a book — any scribbling into a notebook, because that was surely an indication that I was experiencing hypomania and needed a higher dose or a different kind of antipsychotic — he wanted for me to get in touch. He put the fear of God into me that any sign of life in my comatose brain or body meant that I was spiking before crashing into a debilitating depression.

Even after I left him to work with a much more skilled physician, I had this paranoia about feeling good: “Am I hypomanic?” I would ask my psychiatrist. “I don’t want to die today, which clearly means I’m hypomanic, right?” Every emotion and response to life’s events became a symptom. I categorized all crying sessions as “depression,” and filed any type of excitement or energy under “mania.” The terrain between the two, or what we consider “normal,” was a thin thread of land that I visited as often as the Gaza Strip.

But we really should widen our concept of “normal” — challenge ourselves to see our responses, temperaments, and our very selves as more US than illness — explains mental health expert John McManamy in his new book, Not Just Up and Down: Understanding Mood in Bipolar Disorder, the first of aBipolar Expert Series. He writes:

I had no idea when I began this book of the emphasis I would give to “normal.” Once I got several chapters in, though, it became clear I needed to regard normal as a mood episode unto itself, as worthy of our respect as depression and mania and hypomania and anxiety. This was one of those Newton-under-the-apple tree moments for me. From there, “normal” literally took over the book.

If our “normal” fails us, our depressions and manias and anxieties are sure to follow suit. Or, looking at it from a slightly different perspective, if our normal is too fragile, depression and mania and anxiety are going to come crashing through the door. This is where the Socratic injunction to “know thyself” acquires a new sense of urgency.

I’ve known McManamy personally, and have respected his work, for 10 years. We were among the first mental-health bloggers out there going public with our stories, and possibly the only two people at the time who were interjecting a sense of humor into this often somber subject matter. In his past writings and with this book, he has done a masterful job of helping people become experts on their illness and educating them about the history of psychiatry — especially the development of diagnoses included in all versions of the Diagnostic and Statistical Manual of Mental Disorders — so that they can be well-informed participants in their recovery and not be afraid to think for themselves. “My goal in this book is to help make you an expert patient,” he writes in the first chapter, because “patients who take the lead in learning about their illness and in managing their own recovery fare far better than those who simply wait for things to happen.”

McManamy is a perfect guide to help others navigate the messy terrain of bipolar disorder, because not only does he suffer from the illness himself, he also has a wealth of knowledge tucked away in his noggin. He’s studied virtually every classic text on psychiatry and mood disorders — quoting a variety of experts dating back to Hippocrates — and has attended (and sometimes presented at) practically every conference held by the American Psychiatric Association and other professional psychiatric organizations.

All of the chapters contain entertaining anecdotes, interesting studies, and sound advice, but I especially loved what he had to say about “normal,” because going there is brave: What we know is extremely muddled, unclear, and confusing. As McManamy rightly points out, our neat diagnoses confer on us a sense of absolution: “It was my depression that kept me from remembering your birthday, it wasn’t me!” or “My mania took over when I hit on your girlfriend, it’s not my fault!” We see our depression and mania as entities apart from ourselves, even giving them names like “black dog” (Winston Churchill). A sense of detachment benefits us. McManamy writes:

“Normal” doesn’t let us off the hook so easily. It’s personal, it’s painful. We have to come to terms with ourselves. In the long run, though, our enquiry is the source of our salvation. Normal, as we have seen, can be an extremely frightening place. But it is also the repository of all that is good inside us, together with all our hopes and dreams.

I appreciate his insights right now, because I’m starting to reevaluate some of the beliefs I’ve held about my illness for 25 years … like maybe several of those moments I categorized as “depressed” or “manic” were just me. I am a deep thinkerwho tends to reflect (okay, obsess) on the suffering of the world. Maybe that’s my “normal” and not all “illness.” My playfulness is also who I am, not necessarily hypomania.

McManamy’s words made me think about a conversation I had with a friend in 2012.

My husband didn’t have any work at the time. I was working full-time as a government consultant. And both of my kids weren’t sleeping, which then led to a case of terrible insomnia for me. We were in family therapy, which seemed to be making things worse. I was on so much lithium that I was visibly shaking at work meetings and swim practices, which would provoke some really stupid and hurtful questions about my health from people.

“I just want so badly to die,” I said to my friend. “I don’t understand why God won’t allow me to die. Or at least help me find a medication that works.”

“No offense,” he told me, “but anyone in your position would want to kill herself. What you’re feeling is perfectly normal.”

NORMAL.

Huh.

Maybe not normal for a resilient, well-adjusted person who can roll with life’s punches. But for an extremely sensitive person who needs sleep, a job where she feels like she’s making a difference, and a sense of stability at home? Yeah, maybe my response was normal.

McManamy adeptly illustrates the mistake we often make with assigning our temperament to a diagnosis with this example:

Two women are dancing on tables. It’s not the dancing on tables that is at issue – it’s who is dancing on tables. One is Marilyn Monroe. The other is your stereotypical librarian. Marilyn is obviously just being Marilyn. It’s the librarian we have to worry about. Then again, she may be fine.

Throughout the book, he demands that his readers get to know themselves, to evaluate their history of symptoms and life circumstances, and to navel-gaze a bit and explore themselves as if they were a foreign country for which they desire a visa. That knowledge, he asserts, is going to help you expand the time you spend in the normal Gaza Strip of your life, and better manage your episodes in the seas ofdepression and mania that border. Normal is what we’ve striving for, and ironically, we might be there more often than we think we are. Writes McManamy:

Normal is the true starting point in our journey to know thyself, as well as the final destination. In normal, we find our sense of home, as well as our sense of coming home. In one sense, our journey never ends. In another, we’ve already arrived, even if we don’t know it yet. Welcome to normal. Welcome home.