Bipolar4LifeSupport

Recovering from mental illness includes not only getting better, but achieving a full and satisfying life. Many people affirm that their journey to recovery has not been a straight, steady road. Rather there are ups and downs, new discoveries and setbacks. Over time, it is possible to look back and see, despite the halting progress and discouragements, how far we have really come. Each time we reach such a milestone, we see that we have recovered a piece of our lives and we draw new strength from it. The journey to full recovery takes time, but positive changes can happen all along the way.

Stages of Recovery

The first step in the journey to recovery begins with a decision that life must improve. Having a mental illness can affect our lives in many ways:
•Our normal activities suffer;
•Intimate relationships can be profoundly affected;
•Friendships may be lost;
•We may lose employment and financial security.

The pain of mental illness, coupled with such losses, can be overwhelming. Yet at some point we find the determination to stop just surviving, and start gaining back life, piece by piece. That is when recovery begins.
Early on in the recovery process, treatment may focus on finding the right diagnosis and relieving the most severe symptoms. It’s important to realize at this early stage that it is vital to find support from people who understand what you’re going through. Family, friends, your faith community, self-help groups, and community organizations can all be of help.

As time passes, you may find yourself in another stage of recovery. Your condition is becoming more manageable. Many things can contribute to this improvement: an accurate diagnosis, effective medication, supportive talking therapy, and your own growing knowledge of your condition and how to live with it.
Once it was thought that this plateau of stability was as far as people with mental illness could go. Maintaining stability was the goal of treatment. But today we understand that much more is possible. You can expect to return to an active life based on your desires, preferences and abilities.

Finding Hope

Being told that you have a mental illness is not the end of the world. With help and support, you can recover and achieve your life’s ambitions. Of course, you will face many challenges as you begin your treatment, but there is hope. Mental illnesses are manageable. And there are a number of things you can do for yourself after a diagnosis to cope with the news, keep up with your treatment, and support your own recovery.
Understanding of mental illness is much better today than it was in the past. There are different illnesses that require different approaches to treatment. New medications and new types of therapy improve the chance of successful treatment. And , also a lot has been learned, a lot about how people recover and lead full lives.
It’s important to realize that you are not alone. Mental illnesses are common, affecting one in five Americans.

Many people with mental illness, including well-known celebrities, are leading very successful lives. You can gain hope by connecting with other people who share your condition. From them, you will gain insight, experience acceptance, and get invaluable support.
Hope can come from our own inner desire to regain health and live. It also can come from the assurances of people who care about us or from the examples of those who have lived through similar experiences. The more active we are in understanding our condition, taking responsibility for our own care, and reaching out for help, the more chances we have of making gains that give us greater reason to hope.

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Meaningful Work and Recovery:

Although you will encounter roadblocks and setbacks on the road to recovery, working at something that is meaningful to you can bring you a sense of purpose that will anchor you. Meaningful activity expands your sense of self-worth by adding to your skills and helping you accomplish your personal goals and feel good about yourself. Meaningful activity, which includes school, volunteer work, part-time work and full-time employment, also enables you to meet new people and make friends.

We all need some form of meaningful activity in our lives and a means of supporting ourselves, but having a mental health condition can be an obstacle. Mental health conditions impact different people in various ways. Some people with mental health conditions may never stop working; others find that their condition interrupts their career, and still others may be able to do only limited work. As people recover from a mental health condition, they also face varied challenges in relation to work.

Some people with mental health conditions find that they are able, with minor accommodations, to work in the same way they did before. Others may have to re-enter work gradually. And people on disability benefits will need to observe back-to-work rules when employed. No matter your situation and no matter the hurdles you face, hold on to your goals for yourself and keep striving to incorporate meaningful activity into your life. In the past, people with mental illness were often discouraged from working, but today we understand that work is not only a possibility, but it can also play a vital role in recovery. It’s true, however, that having a mental health condition can pose some practical barriers to working, such as having breaks in your career, feeling unsure of yourself, or needing to ask for an accommodation such as time for doctors’ appointments. You can figure out strategies to work around these barriers, often with the help of friends, mentors or an employment specialist. Don’t give up! Supported Employment Your Work Choices Work-Related Issues

Supported Employment

Supported employment services assist you in preparing to work, finding and keeping a job and thriving in a work environment. Depending on where you live, you might be offered supported employment help through the local office of your state’s vocational rehabilitation service, through the mental health agency where you get mental health services, or through a nonprofit disability employment agency. Because of local differences, be sure to check with all of these sources. Your state’s Office of Vocational Rehabilitation should be able to help you find supported employment services. In supported employment, a vocational counselor will help you assess your career interests, job skills, and work challenges. The counselor may suggest job categories that fit your interests, help you write a resume, coach you for interviews, and prepare you for what to expect if you haven’t worked recently. While you will get a lot of help, you will also be expected to work hard on solving problems, planning your career, and looking for jobs. Don’t expect to be handed a job or simply placed in work. The main responsibility will be yours.

The prospect of job hunting can seem daunting, and looking for work is like a job in itself. You need to put in regular hours and keep at it. Perhaps the biggest challenge is getting discouraged. In the competitive marketplace for work, expect to be turned down by many prospective employers before landing a job. An important source of help that many job hunters in your community use is the local public employment office. These days, such offices are typically called “career one-stop centers”.

They offer a wealth of self-help resources on preparing for and finding jobs, computers you can use, and trained staff. Many have a staff person trained as a disability navigator who will understand the challenges you face and guide you to sources of help. Find your state’s network of employment centers here. Once you find a job, your next challenge is to keep it. Work is rewarding, but it also can be tiring, so be sure to get enough rest and care for yourself. Give yourself time to get used to the demands of working. Above all, it’s critical to use your support system – friends and family, your therapist or case manager and peer support group – so you can talk over your experiences at work and get help if your mental health condition is affected. Be sure to let your doctor know that you are going to work and get help in making any needed adjustments to medications as your situation changes.

Your Work Choices

What comes to mind when you think of a job? Is it working full-time, five days a week? If that prospect feels daunting to you, remember that there are other work choices to choose from. One of them might be more suited to your current abilities and stamina, and might be easier to find than full-time work.

Volunteer Work

While many people want to have a paying job, volunteer work is another form of meaningful activity for many people with mental health conditions. Some people use volunteer work as a stepping stone to paid employment; volunteering can help them re-learn skills and grow comfortable working with other people. Others decide to volunteer instead of work. Volunteering not only gives you a sense of pride, but it can make you feel good about yourself to help out in the community.

If you have a cause that you feel passionately about, you may already know where you want to volunteer. Most organizations that have a lot of volunteers will have a coordinator who can help bring you on board. To find volunteer opportunities, you can contact your city or county information line for the contact information for a coordinator. You can also look for “Volunteer Clearinghouse” or “Volunteer Center” in a phone book. The Internet can be a great tool to search for volunteer opportunities; try visiting http://www.volunteermatch.org/ or http://www.1-800-volunteer.org/. Remember that just because you don’t receive a wage as a volunteer doesn’t mean you aren’t entitled to fair treatment and respect. You should feel safe and comfortable in your work environment, and people should treat you like a human being.

Internships

When most people think of internships, they think of college students working for free for credit. Internships aren’t actually student specific; they are a blend of education and work. An internship usually involves a close relationship with other staff at a business working on specific projects and tasks. Where a volunteer might answer phones or bring food to homeless people, an intern might help a program staff member develop strategies to bring the food to the homeless. Sometimes the line between intern and volunteer can be blurred. Some internships will offer an hourly wage or a paid stipend, although such internships can be highly competitive. If you are a full-time college student, ask your career office whether they participate in the U.S. Department of Labor’s Workforce Recruitment Program. Recruiters interview college students with disabilities early in the year for summer intern positions. If you are interested in an internship, make sure you ask your employer at the interview about the specific tasks and projects you will work on. You should expect to spend some of your time doing administrative work like filing, but you should also get a sense of a real opportunity to learn on the job.

Temporary Employment

Temporary employment can be a good bridge to permanent work. You register with a temp agency that can then place you in short-term assignments in companies that need extra help. These assignments could last from a few days to several months and can sometimes lead to an offer of permanent work. By temping, you establish a current resume, sharpen your skills and test your own ability to return to work.

Part-Time Employment

Some people use part-time employment (working less than 35-40 hours a week) to transition to full-time employment; other people find that they prefer working part-time to working full-time permanently. Part-time employment can give you more free time to take care of yourself and your responsibilities. It may be more accommodating if you find that you need more time away from the office to handle your mental health condition. However, part-time employment usually pays less than full-time employment, and part-time work often comes without benefits.

Full-time Employment

Many people with mental health conditions are able to work full-time. Full-time employment usually includes sick leave and may include health insurance, making it easier to handle health problems. Company retirement plans for full-time employees enable you to grow your savings. You may want to look for government work, as local, state and federal employers have a good record of hiring diversity and respecting disability regulations. Finding employment, whether full-time or part-time, usually involves preparing your own resume and job-hunting in your local employment market. Job hunting can be discouraging for anyone, especially if job openings are scarce and there is a lot of competition. If you are having a hard time finding a job, you can look for help from an employment agency, supported employment services or close family members or friends. It is important to have support while job hunting; seek it from friends, from a job-hunting club, a support group, or a peer-run drop-in center.

Self-Employment

Some people are not interested in traditional employment-working for someone else-but are able to work for themselves. You might want to start and grow your own business. Do you have a product or service that you can sell? Do you have a hobby or skill like jewelry making, baking, or playing and instrument? Can you provide a service such as lawn mowing, pet-sitting, or writing and editing? Working for yourself enables you to set your own schedule, and avoids the problem of disclosing your condition that sometimes arises in the workplace. On the other hand, it demands self-discipline and for tax purposes, you need to track your expenses and income. To prepare yourself, develop a simple business plan that outlines what you plan to sell, your customers, your competition, and your expenses. You can get help with starting your own business from local offices of the Small Business Administration, your county or state economic development office or craft guilds and associations. Also, be sure to contact your state’s vocational rehabilitation office for help with self-employment. The Abilities Fund (http://www.abilitiesfund.org/index.php) is an organization that provides assistance to people with disabilities interested in self-employment and entrepreneurship.

Common Work-Related Issues

How will working affect my government benefits?

If you have a mental health condition, you may receive Social Security or other government-funded disability benefits, or private disability benefits from a previous employer. While disability benefits typically pay below a wage you would expect to get while working, they provide regular income. Additionally, if you are on disability and/or below the poverty line, you may receive health care through Medicaid or Medicare. Remember, too, that eligibility for housing programs and the rent you pay may be affected by your income. Having a paying job or earning other types of income can affect your status in Medicaid or Medicare.

This does not mean you should be afraid to work, it means it is important to understand the rules before you work. While the interaction between Medicaid and Medicare can be complicated, under either program, you can earn a certain amount of money without losing your benefits. Because everyone’s situation is different, you should always talk to a trusted and knowledgeable person who can help you understand your work options and how your choices will affect your benefits. A good starting place is reading about Social Security Administration

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How Light Affects the Brain: Dr. Phelps a supporter and contributer to Bipolar4LifeSupport PART #1

You know about rods and cones, right? Those are the two kinds of receptors in your eyeball, on your retina, for light. But you didn’t know that there is another receptor for light in the eye (I’m guessing you don’t know, because until I came across this research, I didn’t know either).

Whereas the rods and cones send information to the visual cortex (the “occipital cortex”, at the back of your head), this other light receptor sends its information to your internal clock. The nerve cables from these receptors don’t even go to the vision center at all. They go straight to the middle of your brain, to a region of the hypothalamus called the suprachiasmatic nucleus, which is well known to be the location of the biological clock for us humans. (That’s an oversimplification but the general idea is correct. For the minute details, light researchers would prefer an overview and series of articles in Nature 2005).

You know about this clock, right? Everybody has one: it’s the gizmo that is setting your biological rhythms every day — when you feel like eating, when you feel like sleeping, when you feel like getting up in the morning. It’s the gizmo that gets confused by east-west travel, causing “jet lag”. It regulates hundreds of chemical reactions all timed to match the natural cycle of days and nights in our environment.
Or what used to be our environment. Nowadays we’ve altered that environment in many ways, of course (Nature is getting ready to get back at us, big time; but hey, that’s our kids’ worry, right?). One of the most significant changes in our environment is our ability to have LIGHT when we used to have DARKNESS.

But our brains were not built for this. There were built for a regular period of darkness within every 24 hours (by whom or what doesn’t matter right now; don’t stop, read my page on evolution later. I keep interrupting you with these big-picture ideas like God and global warming. I must be worried about something). Some people are not very strongly affected by our artificially lit environment. But some people, perhaps especially those with bipolar disorder, may suffer when they get too little, or too much. Right now most such people just have to learn this the hard way. Read on.

From the retina, to the biological clock: then what?

Your biological clock resets itself every day by the appearance of morning light. That’s why you can, over a few days, adjust your clock if you fly to some other continent, or even across one. As you may know, our biological clocks are not perfect 24-hour machines. They drift a little bit every day. Most people drift toward a longer day (their clock takes more than 24 hours to complete a cycle). This is probably why most people find it easier to stay up late than to wake up early. For some people, that drift toward later hours can be very dramatic. They may be the ones who most need to learn about what I’m presenting here. They don’t stay glued to “real time” very well. They need to avoid getting “unglued” any further. And light at night may be one of the most important ungluing factors.

So, how does the clock reset itself?

Here’s the short answer. The long answer is a beautiful example of brain science; I’ll send you there in a minute if you’re interested. Briefly then: every morning light turns off a chemical process and allows the clock process, which is a very interesting string of chemical reactions, to start all over again. Clock researchers have identified all the important molecules in this process. Lo and behold: lithium directly affects one of the key enzymes in the resetting of the clock. Here we find “ground zero” of our biological rhythms, the very center of the clock process, and there’s lithium right in the middle of it.

Very interesting. If that’s enough to get you interested, have a look at the long story about how the clock works, including how lithium affects it.

Light is central to biological rhythms — and so is DARKNESS

If light starts the clock every day, is it possible that darkness is a necessary ingredient as well? Look at the question this way: sleep deprivation can cause manic episodes. In part that’s too little sleep itself — but might part of the story be “too much light?” Generally when people are sleeping less and heading toward mania, they’re not hanging out in the dark. They’re up late at night in very well lit places, like casinos, roadways with bright car lights in their eyes, their office preparing the big talk that will secure their future millions, and so forth. They’re not sitting in some dark room. Is there any chance that being forced to stay in the dark during an emerging manic episode could actually turn them in the other direction? We’ll look at some evidence for that in just a moment.

Here’s another angle on light and dark: suppose that the appearance of light every morning can reset your clock only when you’ve had enough darkness. Maybe the brain needs to be able to see the contrast? What would happen if you didn’t get enough darkness? Maybe you’d lose your biological rhythm entirely; your body wouldn’t know when to make you sleep and when to wake you up. You’d be up in the middle of the night sometimes, for days in a row, backwards to real time. Then you might be so asleep during the real day you could hardly get out of bed; getting up in the morning would feel like getting up from sleep in the middle of the night does for the rest of us, ugh.

And finally, imagine that if your clock cuts loose from real time, you lose even the 24-hour connection.

Remember, the clock is not really a 24 hour machine in most people. Maybe you would lose your rhythm entirely so that you body could do the sleep thing, or the really awake thing, at any time, on any day. You’d have no idea where you were, in terms of body cycling, totally erratic. Extreme forms of “rapid cycling bipolar disorder” look just like this: no rhythm at all.

All of these lines of thought led a research team at the National Institute of Mental Health to wonder: maybe some people with rapid-cycling bipolar disorder have lost the connection between their internal clock and external light/dark reality. Maybe one way to treat that would be to simply “enforce darkness”! The results of their test of this idea will be described in a moment.

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Dr. Phelps says:

Treatment Implications: Part # 2 Part #3 next

There are two aspects of this story with major implications for
treatment of bipolar disorder: first, sleep and rhythm; and then, darkness and
light (particularly one kind of light).

Sleep and Rhythm
This one’s pretty simple. Everybody
needs sleep. But people with bipolar disorder need to protect it. Sleep
deprivation is associated with having manic symptoms. But perhaps even more
important than sleep, or at least as important, is rhythm: the sleep needs to
happen at the same time every day to keep your clock organized. Move it around
too much and you may be setting yourself up for cycling, perhaps even the harder
to treat version, “rapid cycling”.

Thus most people with bipolar disorder will not be able to do
“shift work”, where the work day is rotating around the clock. That’s probably
about the worst kind of job schedule you could arrange. A close second worst is
might be an international job like pilot or flight attendant, changing time
zones over and over again. Third worst would be graveyard shift work, unless
you were extremely attentive to keeping your light exposure limited to your
“day”, and avoiding real daylight during your “night” (heavy blinds and a sleep
mask, for example). Even then we might wonder if there’s something about “real”
daylight that’s important to synchronize with your internal clock.

So, the treatment bottom line: have regular sleep hours — even on
weekends. I know, it’s going to feel really stupid to be getting up at 6 am on a
Saturday. You’ll probably have to conduct some personal tests to find out if
this is really worth it. I’ll admit: even if it’s theoretically a good idea for
the long run, you’ll probably never be able to keep it up unless you discover
some shorter-term benefit as well. So keep some mood/energy/sleep records
(several charts are linked from my home page; bottom bullet in the Bipolar II
section) and see what you think.

Darkness and Light
The following recommendations are
not standard. You won’t hear these from your doctor, for a while yet, anyway.
They are just my opinions, some logical extensions from our existing knowledge.
But since they are easy and safe, I don’t have to worry too much about being
right! You can try one, or several, and see what you think.

In my opinion, everything you just finished reading suggests that
if you have bipolar disorder, you should very deliberately manage your exposure
to light and darkness, especially darkness. I think this may be as important for
some people with bipolar disorder as regular sleep. Obviously the easiest way to
arrange this would be to make sure you’re getting good quality darkness when
you’re asleep. That means no nightlights (in one study, as little as 1/500th of
midday sunlight, just 200 lux, was enough to disturb people’s melatonin, the
sleep chemical in our brainHallam).
That means don’t turn on the lights in the middle of the night if you get up to
go to the bathroom (no hallway nightlight either). Don’t let early morning sun,
in the summer, hit your closed eyelids (which means using, if you have to, a
$3.50 sleep mask you can buy at the pharmacy. You’ll get used to it. Older guys
who have to get up to urinate anyway can put it on before going back to sleep in
the middle of the night).

Here a stunning case example to demonstrate how powerful “Dark
Therapy” can be: a patient with severe rapid-cycling bipolar disorder who
stopped cycling entirely — with no medications — just by carefully
using very regular darkness (first 14 hrs a night, then within a few weeks, to
stay well, only 10 hrs. a night). The graphs of his mood chart, before and after
this treatment, are amazing. You can see those graphs on my page about Dark
Therapy.

No nightlights? A reader suggested this might carry risk —
bruising your shin! Or worse, a fall. So, you can use nightlights, actually, but
they have to emit no blue light, as you’ll see in the next section.

Alert, Alert: watch out for one kind of light at
night.
Recent research has shown that one particular kind of light is
the key to regulating the biological clock: blue light. For an explanation of
that research, see Why Blue Light is So Important.
The bottom line: blue light is a powerful signal telling your brain “it’s
morning time, wake up!” Although not formally tested yet, it looks like the
last thing you’d want to be doing right before bed is looking at a blue light.
Uh, oh. You can see it coming, can’t you: what color is the light from your
television? How about from the computer screen you’re staring at right now?
(not after 9 pm, is it? uh oh…)

The good news is this: you might be able to significantly
regulate your bipolar cycling, and at least find it easier to go to sleep at
night (without medications like zolpidem (Ambien), lorazepam (Ativan),
trazodone, etc.), by avoiding blue light at night. So, here’s the treatment
recommendation doctors ought to be giving you (if they had the time to read the
recent research in this area, which few do): no TV or computer after 9 pm if
you’re going to bed at 10 or 11. End the TV/computer even earlier if you go to
bed earlier. I’ve had quite a few patients tell me this step alone really
helped them. If you took the link above to the story about the guy whose rapid
cycling was treated with “Dark
Therapy” and no medications, you can see how closely this recommendation
matches that treatment.

A related step, recommended by Dr. Dave Avery, the light
researcher at the University of Washington: get dimmers on all the lights you
use after 9 pm and start turning them down around that time. In particular,
avoid going in to brush your teeth at 10 pm and turning on the shaving lights!
It’s just the wrong message to be sending your brain at that hour. If you have
to use some sort of “night light” to guide your way to the bathroom in the
middle of the night, use one that emits no blue light. Here’s a source of such
nightlights.

Some people are very susceptible to light; others are not. But if
you’re one who is, these could be very important ideas to consider. One woman
wrote, after reading this section:

“My daughter was very recently diagnosed with Bi-polar II. I found
your site while trying to understand what she is dealing with. When I read the
article about darkness, I was amazed. My own sleep patterns are poor at best, so
I decided to try some of your suggestions. I got away from the computer and the
television two hours before retiring for the night. I bought an eye mask. In a
little over a week, I have gone from waking up 3 to 5 times a night (and not
falling back to sleep) and getting out of bed to awaking once to turn over and
fall right back to sleep! I am at the point where I am telling anyone who will
listen to me.”

Yellow Eyeglasses to Avoid Blue Light?
This is going to
be fashionable, trust me. In fact, it may already be fashionable (I
wouldn’t be the guy to ask…) At least I’m not making any money on this, so you
don’t have to distrust it for that reason– as otherwise you should!

This idea is not yet tested. I wouldn’t even talk about it if it
weren’t utterly safe … and kind of a neat idea! It may even be pretty cheap:
$7-$10. You’ve learned here that blue light is the strongest signal telling your
brain to wake up (e.g. that page on Why Blue Light is So
Important. If you still don’t trust me on this — good! — here’s a health
reporter describing the entire history of blue light research — fascinating,
moderately technical but still plain english: Holtzman).

So, if you just had to use your computer after 9 pm; or if
for some reason you just have to use your TV after 9 pm… go ahead, try
to convince me…. what about putting on a pair of glasses that could block out
blue light? This might make it easier to fall asleep, as the signal telling your
brain “wake up!” would be blocked.

Hey, this is not as wacko an idea as it sounds. People are
already using it. I’ll show you a research result in a moment, but you may find
these business-related stories even more convincing: a company from the
Netherlands has started making a kind of fluorescent light that can vary the
amount of blue and red light through the day — including more blue in the
afternoon to help you stay awake after lunch! An American company makes 5
different products that limit your exposure to blue light at night (no-blue
bulbs, including fluorescent and LED; blue-blocking sunglasses; and a
blue-blocking filter to put over your computer screen (their site is http://www.lowbluelights.com , and they are
really nice folks; but there is a cheaper source for their blue-blocking glasses
described below). And a small American study of people with Alzheimer’s disease
showed that by using early evening blue light exposure, they could keep these
folks awake later into the evening, so that they didn’t fall asleep at 7 pm and
then wake up in the middle of the night.JAMA Both of these
uses are described in this article on blue light and
circadian rhythms in Science News from 5/2006.

Another important study showed that blocking blue light at night
really does change brain chemistry, just as one would hope. Here’s how that was
done. Melatonin, a hormone associated with falling and staying asleep, is
decreased by light. That fact is very well established. What’s new is that you
can prevent this reduction in melatonin by blocking blue light, with a
simple pair of glasses made to block that particular color of light. They let
everything else through. Things look pretty yellow through these things, but to
your brain, it’s like darkness! What a trick. This crucial article, which
shows that a simple maneuver like wearing a pair of weird glasses really can
protect your sleep hormones, was published in 2005.Kayumov

[Update 9/2010: The next step in this research will be a
“randomized trial” in which some people with sleep problems are given either the
amber lenses or a similar “control” lens that does not block blue light. Two
small pilot-studies leading toward just such a large-scale test have been
published in both
reports, results suggest that amber lenses do indeed improve sleep.]